Surgical hub spatial awareness to determine devices in operating theater

ABSTRACT

A surgical hub is disclosed. The surgical hub includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive first image data from a first image sensor, the first image data represents a first field of view, receive second image data from a second image sensor, wherein the second image data represents a second field of view, and display, on a display coupled to the processor, a first image rendered from the first image data corresponding to the first field of view and a second image rendered from the second image data corresponding to the second field of view.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority under 35 U.S.C. 119(e)to U.S. Provisional Patent Application Ser. No. 62/649,309, titledSURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER, filed Mar. 28, 2018, the disclosure of which is hereinincorporated by reference in its entirety.

This application also claims the benefit of priority under 35 U.S.C.119(e) to U.S. Provisional Patent Application Ser. No. 62/611,341,titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, of U.S.Provisional Patent Application Ser. No. 62/611,340, titled CLOUD-BASEDMEDICAL ANALYTICS, filed Dec. 28, 2017, of U.S. Provisional PatentApplication Ser. No. 62/611,339, titled ROBOT ASSISTED SURGICALPLATFORM, filed Dec. 28, 2017, the disclosure of each of which is hereinincorporated by reference in its entirety.

BACKGROUND

The present disclosure relates to various surgical systems. Surgicalprocedures are typically performed in surgical operating theaters orrooms in a healthcare facility such as, for example, a hospital. Asterile field is typically created around the patient. The sterile fieldmay include the scrubbed team members, who are properly attired, and allfurniture and fixtures in the area. Various surgical devices and systemsare utilized in performance of a surgical procedure.

SUMMARY

In one general aspect, a surgical hub is provided. The general hubcomprises a processor; and a memory coupled to the processor, the memorystoring instructions executable by the processor to: receive first imagedata from a first image sensor, wherein the first image data representsa first field of view; receive second image data from a second imagesensor, wherein the second image data represents a second field of view;and display, on a display coupled to the processor, a first imagerendered from the first image data corresponding to the first field ofview and a second image rendered from the second image datacorresponding to the second field of view.

In another general aspect, a surgical hub is provided. The surgical hubcomprises a processor; and a memory coupled to the processor, the memorystoring instructions executable by the processor to: detect a surgicaldevice connection to the surgical hub; transmit a control signal to thedetected surgical device to transmit to the surgical hub surgicalparameter data associated with the detected surgical device; receive thesurgical parameter data from the detected surgical device; receive imagedata from an image sensor; and display, on a display coupled to thesurgical hub, an image rendered based on the image data received fromthe image sensor in conjunction with the surgical parameter datareceived from the surgical device.

In another general aspect, a surgical hub is provided. The surgical hubcomprises a control circuit configured to: detect a surgical deviceconnection to the surgical hub; transmit a control signal to thedetected surgical device to transmit to the surgical hub surgicalparameter data associated with the detected surgical device; receive thesurgical parameter data from the detected surgical device; receive imagedata from an image sensor; and display, on a display coupled to thesurgical hub, an image received from the image sensor in conjunctionwith the surgical parameter data received from the surgical device.

In another general aspect, a non-transitory computer readable medium isprovided. The non-transitory computer readable medium stores computerreadable instructions which, when executed, causes a machine to: detecta surgical device connection to the surgical hub; transmit a controlsignal to the detected surgical device to transmit to the surgical hubsurgical parameter data associated with the detected surgical device;receive the surgical parameter data from the detected surgical device;receive image data from an image sensor; and display, on a displaycoupled to the surgical hub, an image received from the image sensor inconjunction with the surgical parameter data received from the surgicaldevice.

In another general aspect, a non-transitory computer readable medium isprovided. The non-transitory computer readable medium stores computerreadable instructions which, when executed, causes a machine to: receivefirst image data from a first image sensor, wherein the first image datarepresents a first field of view; receive second image data from asecond image sensor, wherein the second image data represents a secondfield of view; and display, on a display coupled to the surgical hub, afirst image corresponding to the first field of view and a second imagecorresponding to the second field of view.

FIGURES

The features of various aspects are set forth with particularity in theappended claims. The various aspects, however, both as to organizationand methods of operation, together with further objects and advantagesthereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a block diagram of a computer-implemented interactive surgicalsystem, in accordance with at least one aspect of the presentdisclosure.

FIG. 2 is a surgical system being used to perform a surgical procedurein an operating room, in accordance with at least one aspect of thepresent disclosure.

FIG. 3 is a surgical hub paired with a visualization system, a roboticsystem, and an intelligent instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 4 is a partial perspective view of a surgical hub enclosure, and ofa combo generator module slidably receivable in a drawer of the surgicalhub enclosure, in accordance with at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of a combo generator module with bipolar,ultrasonic, and monopolar contacts and a smoke evacuation component, inaccordance with at least one aspect of the present disclosure.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing configured to receivea plurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 7 illustrates a vertical modular housing configured to receive aplurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 8 illustrates a surgical data network comprising a modularcommunication hub configured to connect modular devices located in oneor more operating theaters of a healthcare facility, or any room in ahealthcare facility specially equipped for surgical operations, to thecloud, in accordance with at least one aspect of the present disclosure.

FIG. 9 illustrates a computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure.

FIG. 10 illustrates a surgical hub comprising a plurality of modulescoupled to the modular control tower, in accordance with at least oneaspect of the present disclosure.

FIG. 11 illustrates one aspect of a Universal Serial Bus (USB) networkhub device, in accordance with at least one aspect of the presentdisclosure.

FIG. 12 illustrates a logic diagram of a control system of a surgicalinstrument or tool, in accordance with at least one aspect of thepresent disclosure.

FIG. 13 illustrates a control circuit configured to control aspects ofthe surgical instrument or tool, in accordance with at least one aspectof the present disclosure.

FIG. 14 illustrates a combinational logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 15 illustrates a sequential logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions, inaccordance with at least one aspect of the present disclosure.

FIG. 17 is a schematic diagram of a robotic surgical instrumentconfigured to operate a surgical tool described herein, in accordancewith at least one aspect of the present disclosure.

FIG. 18 illustrates a block diagram of a surgical instrument programmedto control the distal translation of a displacement member, inaccordance with at least one aspect of the present disclosure.

FIG. 19 is a schematic diagram of a surgical instrument configured tocontrol various functions, in accordance with at least one aspect of thepresent disclosure.

FIG. 20 is a simplified block diagram of a generator configured toprovide inductorless tuning, among other benefits, in accordance with atleast one aspect of the present disclosure.

FIG. 21 illustrates an example of a generator, which is one form of thegenerator of FIG. 20, in accordance with at least one aspect of thepresent disclosure.

FIG. 22 illustrates a diagram of a surgical instrument centered on alinear staple transection line using the benefit of centering tools andtechniques described in connection with FIGS. 23-35, in accordance withat least one aspect of the present disclosure.

FIGS. 23-25 illustrate a process of aligning an anvil trocar of acircular stapler to a staple overlap portion of a linear staple linecreated by a double-stapling technique, in accordance with at least oneaspect of the present disclosure, where:

FIG. 23 illustrates an anvil trocar of a circular stapler that is notaligned with a staple overlap portion of a linear staple line created bya double-stapling technique;

FIG. 24 illustrates an anvil trocar of a circular stapler that isaligned with the center of the staple overlap portion of the linearstaple line created by a double-stapling technique; and

FIG. 25 illustrates a centering tool displayed on a surgical hub displayshowing a staple overlap portion of a linear staple line created by adouble-stapling technique to be cut out by a circular stapler, where theanvil trocar is not aligned with the staple overlap portion of thedouble staple line as shown in FIG. 23.

FIGS. 26 and 27 illustrate a before image and an after image of acentering tool, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 26 illustrates an image of a projected cut path of an anvil trocarand circular knife before alignment with the target alignment ringcircumscribing the image of the linear staple line over the image of thestaple overlap portion presented on a surgical hub display; and

FIG. 27 illustrates an image of a projected cut path of an anvil trocarand circular knife after alignment with the target alignment ringcircumscribing the image of the linear staple line over the image of thestaple overlap portion presented on a surgical hub display.

FIGS. 28-30 illustrate a process of aligning an anvil trocar of acircular stapler to a center of a linear staple line, in accordance withat least one aspect of the present disclosure, where:

FIG. 28 illustrates the anvil trocar out of alignment with the center ofthe linear staple line;

FIG. 29 illustrates the anvil trocar in alignment with the center of thelinear staple line; and

FIG. 30 illustrates a centering tool displayed on a surgical hub displayof a linear staple line, where the anvil trocar is not aligned with thestaple overlap portion of the double staple line as shown in FIG. 28.

FIG. 31 is an image of a standard reticle field view of a linear stapleline transection of a surgical as viewed through a laparoscope displayedon the surgical hub display, in accordance with at least one aspect ofthe present disclosure.

FIG. 32 is an image of a laser-assisted reticle field of view of thesurgical site shown in FIG. 31 before the anvil trocar and circularknife of the circular stapler are aligned to the center of the linearstaple line, in accordance with at least one aspect of the presentdisclosure.

FIG. 33 is an image of a laser-assisted reticle field of view of thesurgical site shown in FIG. 32 after the anvil trocar and circular knifeof the circular stapler are aligned to the center of the linear stapleline, in accordance with at least one aspect of the present disclosure.

FIG. 34 illustrates a non-contact inductive sensor implementation of anon-contact sensor to determine an anvil trocar location relative to thecenter of a staple line transection, in accordance with at least oneaspect of the present disclosure.

FIGS. 35A and 35B illustrate one aspect of a non-contact capacitivesensor implementation of the non-contact sensor to determine an anviltrocar location relative to the center of a staple line transection, inaccordance with at least one aspect of the present disclosure, where:

FIG. 35A shows the non-contact capacitive sensor without a nearby metaltarget; and

FIG. 35B shows the non-contact capacitive sensor near a metal target.

FIG. 36 is a logic flow diagram of a process depicting a control programor a logic configuration for aligning a surgical instrument, inaccordance with at least one aspect of the present disclosure.

FIG. 37 illustrates a primary display of the surgical hub comprising aglobal and local display, in accordance with at least one aspect of thepresent disclosure.

FIG. 38 illustrates a primary display of the surgical hub, in accordancewith at least one aspect of the present disclosure.

FIG. 39 illustrates a clamp stabilization sequence over a five secondperiod, in accordance with at least one aspect of the presentdisclosure.

FIG. 40 illustrates a diagram of four separate wide angle view images ofa surgical site at four separate times during the procedure, inaccordance with at least one aspect of the present disclosure.

FIG. 41 is a graph of tissue creep clamp stabilization curves for twotissue types, in accordance with at least one aspect of the presentdisclosure.

FIG. 42 is a graph of time dependent proportionate fill of a clamp forcestabilization curve, in accordance with at least one aspect of thepresent disclosure.

FIG. 43 is a graph of the role of tissue creep in the clamp forcestabilization curve, in accordance with at least one aspect of thepresent disclosure.

FIGS. 44A and 44B illustrate two graphs for determining when the clampedtissue has reached creep stability, in accordance with at least oneaspect of the present disclosure, where:

FIG. 44A illustrates a curve that represents a vector tangent angle dθas a function of time; and

FIG. 44B illustrates a curve that represents change in force-to-close(ΔFTC) as a function of time.

FIG. 45 illustrates an example of an augmented video image of apre-operative video image augmented with data identifying displayedelements, in accordance with at least one aspect of the presentdisclosure.

FIG. 46 is a logic flow diagram of a process depicting a control programor a logic configuration to display images, in accordance with at leastone aspect of the present disclosure.

FIG. 47 illustrates a communication system comprising an intermediatesignal combiner positioned in the communication path between an imagingmodule and a surgical hub display, in accordance with at least oneaspect of the present disclosure.

FIG. 48 illustrates an independent interactive headset worn by a surgeonto communicate data to the surgical hub, according to one aspect of thepresent disclosure.

FIG. 49 illustrates a method for controlling the usage of a device, inaccordance with at least one aspect of the present disclosure, inaccordance with at least one aspect of the present disclosure.

FIG. 50 illustrates a surgical system that includes a handle having acontroller and a motor, an adapter releasably coupled to the handle, anda loading unit releasably coupled to the adapter, in accordance with atleast one aspect of the present disclosure.

FIG. 51 illustrates a verbal Automated Endoscopic System for OptimalPositioning (AESOP) camera positioning system, in accordance with atleast one aspect of the present disclosure.

FIG. 52 illustrates a multi-functional surgical control system andswitching interface for virtual operating room integration, inaccordance with at least one aspect of the present disclosure.

FIG. 53 illustrates a diagram of a beam source and combined beamdetector system utilized as a device control mechanism in an operatingtheater, in accordance with at least one aspect of the presentdisclosure.

FIGS. 54A-E illustrate various types of sterile field control and datainput consoles, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 54A illustrates a single zone sterile field control and data inputconsole;

FIG. 54B illustrates a multi zone sterile field control and data inputconsole;

FIG. 54C illustrates a tethered sterile field control and data inputconsole;

FIG. 54D illustrates a battery operated sterile field control and datainput console; and

FIG. 54E illustrates a battery operated sterile field control and datainput console.

FIGS. 55A-55B illustrate a sterile field console in use in a sterilefield during a surgical procedure, in accordance with at least oneaspect of the present disclosure, where:

FIG. 55A shows the sterile field console positioned in the sterile fieldnear two surgeons engaged in an operation; and

FIG. 55B shows one of the surgeons tapping the touchscreen of thesterile field console.

FIG. 56 illustrates a process for accepting consult feeds from anotheroperating room, in accordance with at least one aspect of the presentdisclosure.

FIG. 57 illustrates a standard technique for estimating vessel path anddepth and device trajectory, in accordance with at least one aspect ofthe present disclosure.

FIGS. 58A-58D illustrate multiple real time views of images of a virtualanatomical detail for dissection, in accordance with at least one aspectof the present disclosure, where:

FIG. 58A is a perspective view of the virtual anatomical detail;

FIG. 58C is a side view of the virtual anatomical detail;

FIG. 58B is a perspective view of the virtual anatomical detail; and

FIG. 58D is a side view of the virtual anatomical detail.

FIGS. 59A-59B illustrate a touchscreen display that may be used withinthe sterile field, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 59A illustrates an image of a surgical site displayed on atouchscreen display in portrait mode;

FIG. 59B shows the touchscreen display rotated in landscape mode and thesurgeon uses his index finger to scroll the image in the direction ofthe arrows;

FIG. 59C shows the surgeon using his index finger and thumb to pinchopen the image in the direction of the arrows to zoom in;

FIG. 59D shows the surgeon using his index finger and thumb to pinchclose the image in the direction of the arrows to zoom out; and

FIG. 59E shows the touchscreen display rotated in two directionsindicated by arrows to enable the surgeon to view the image in differentorientations.

FIG. 60 illustrates a surgical site employing a smart retractorcomprising a direct interface control to a surgical hub, in accordancewith at least one aspect of the present disclosure.

FIG. 61 illustrates a surgical site with a smart flexible stickerdisplay attached to the body of a patient, in accordance with at leastone aspect of the present disclosure.

FIG. 62 is a logic flow diagram of a process depicting a control programor a logic configuration to communicate from inside a sterile field to adevice located outside the sterile field, in accordance with at leastone aspect of the present disclosure.

FIG. 63 illustrates a system for performing surgery, in accordance withat least one aspect of the present disclosure.

FIG. 64 illustrates a second layer of information overlaying a firstlayer of information, in accordance with at least one aspect of thepresent disclosure.

FIG. 65 depicts a perspective view of a surgeon using a surgicalinstrument that includes a handle assembly housing and a wirelesscircuit board during a surgical procedure, with the surgeon wearing aset of safety glasses, in accordance with at least one aspect of thepresent disclosure.

FIG. 66 is a schematic diagram of a feedback control system forcontrolling a surgical instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 67 illustrates a feedback controller that includes an on-screendisplay module and a heads up display (HUD) module, in accordance withat least one aspect of the present disclosure.

FIG. 68 is a timeline depicting situational awareness of a surgical hub,in accordance with at least one aspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Mar. 28, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/649,302, titled        INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION        CAPABILITIES;    -   U.S. Provisional Patent Application Ser. No. 62/649,294, titled        DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE        ANONYMIZED RECORD;    -   U.S. Provisional Patent Application Ser. No. 62/649,300, titled        SURGICAL HUB SITUATIONAL AWARENESS;    -   U.S. Provisional Patent Application Ser. No. 62/649,309, titled        SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING        THEATER;    -   U.S. Provisional Patent Application Ser. No. 62/649,310, titled        COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;    -   U.S. Provisional Patent Application Ser. No. 62/649,291, titled        USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE        PROPERTIES OF BACK SCATTERED LIGHT;    -   U.S. Provisional Patent Application Ser. No. 62/649,296, titled        ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;    -   U.S. Provisional Patent Application Ser. No. 62/649,333, titled        CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND        RECOMMENDATIONS TO A USER;    -   U.S. Provisional Patent Application Ser. No. 62/649,327, titled        CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION        TRENDS AND REACTIVE MEASURES;    -   U.S. Provisional Patent Application Ser. No. 62/649,315, titled        DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;    -   U.S. Provisional Patent Application Ser. No. 62/649,313, titled        CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;    -   U.S. Provisional Patent Application Ser. No. 62/649,320, titled        DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. Provisional Patent Application Ser. No. 62/649,307, titled        AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS; and    -   U.S. Provisional Patent Application Ser. No. 62/649,323, titled        SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. ______, titled INTERACTIVE        SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;        Attorney Docket No. END8499USNP/170766;    -   U.S. patent application Ser. No. ______, titled INTERACTIVE        SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA        CAPABILITIES;    -   U.S. patent application Ser. No. ______, titled SURGICAL HUB        COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM        DEVICES; Attorney Docket No. END8499USNP2/170766-2;    -   U.S. patent application Ser. No. ______, titled SPATIAL        AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; Attorney Docket        No. END8499USNP3/170766-3;    -   U.S. patent application Ser. No. ______, titled COOPERATIVE        UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY        INTELLIGENT SURGICAL HUBS; Attorney Docket No.        END8499USNP4/170766-4;    -   U.S. patent application Ser. No. ______, titled SURGICAL HUB        CONTROL ARRANGEMENTS; Attorney Docket No. END8499USNP5/170766-5;    -   U.S. patent application Ser. No. ______, titled DATA STRIPPING        METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED        RECORD; Attorney Docket No. END8500USNP/170767;    -   U.S. patent application Ser. No. ______, titled COMMUNICATION        HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A        SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;        Attorney Docket No. END8500USNP1/170767-1;    -   U.S. patent application Ser. No. ______, titled SELF DESCRIBING        DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT; Attorney Docket        No. END8500USNP2/170767-2;    -   U.S. patent application Ser. No. ______, titled DATA PAIRING TO        INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;        Attorney Docket No. END8500USNP3/170767-3;    -   U.S. patent application Ser. No. ______, titled SURGICAL HUB        SITUATIONAL AWARENESS; Attorney Docket No. END8501USNP/170768;    -   U.S. patent application Ser. No. ______, titled SURGICAL SYSTEM        DISTRIBUTED PROCESSING; Attorney Docket No.        END8501USNP1/170768-1;    -   U.S. patent application Ser. No. ______, titled AGGREGATION AND        REPORTING OF SURGICAL HUB DATA; Attorney Docket No.        END8501USNP2/170768-2;    -   U.S. patent application Ser. No. ______, titled DISPLAY OF        ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;        Attorney Docket No. END8502USNP1/170769-1;    -   U.S. patent application Ser. No. ______, titled STERILE FIELD        INTERACTIVE CONTROL DISPLAYS; Attorney Docket No.        END8502USNP2/170769-2;    -   U.S. patent application Ser. No. ______, titled COMPUTER        IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; Attorney Docket No.        END8503USNP/170770;    -   U.S. patent application Ser. No. ______, titled USE OF LASER        LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF        BACK SCATTERED LIGHT; Attorney Docket No. END8504USNP/170771;    -   U.S. patent application Ser. No. ______, titled CHARACTERIZATION        OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT        REFRACTIVITY; Attorney Docket No. END8504USNP1/170771-1; and    -   U.S. patent application Ser. No. ______, titled DUAL CMOS ARRAY        IMAGING; Attorney Docket No. END8504USNP2/170771-2.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. ______, titled ADAPTIVE CONTROL        PROGRAM UPDATES FOR SURGICAL DEVICES; Attorney Docket No.        END8506USNP/170773;    -   U.S. patent application Ser. No. ______, titled ADAPTIVE CONTROL        PROGRAM UPDATES FOR SURGICAL HUBS; Attorney Docket No.        END8506USNP1/170773-1;    -   U.S. patent application Ser. No. ______, titled CLOUD-BASED        MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A        USER; Attorney Docket No. END8507USNP/170774;    -   U.S. patent application Ser. No. ______, titled CLOUD-BASED        MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE        RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET; Attorney        Docket No. END8507USNP1/170774-1;    -   U.S. patent application Ser. No. ______, titled CLOUD-BASED        MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED        INDIVIDUALIZATION OF INSTRUMENT FUNCTION; Attorney Docket No.        END8507USNP2/170774-2;    -   U.S. patent application Ser. No. ______, titled CLOUD-BASED        MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND        REACTIVE MEASURES; Attorney Docket No. END8508USNP/170775;    -   U.S. patent application Ser. No. ______, titled DATA HANDLING        AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; Attorney Docket        No. END8509USNP/170776; and    -   U.S. patent application Ser. No. ______, titled CLOUD INTERFACE        FOR COUPLED SURGICAL DEVICES; Attorney Docket No.        END8510USNP/170777.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. ______, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8511USNP/170778;    -   U.S. patent application Ser. No. ______, titled COMMUNICATION        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8511USNP1/170778-1;    -   U.S. patent application Ser. No. ______, titled CONTROLS FOR        ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No.        END8511USNP2/170778-2;    -   U.S. patent application Ser. No. ______, titled AUTOMATIC TOOL        ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8512USNP/170779;    -   U.S. patent application Ser. No. ______, titled CONTROLLERS FOR        ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney Docket No.        END8512USNP1/170779-1;    -   U.S. patent application Ser. No. ______, titled COOPERATIVE        SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8512USNP2/170779-2;    -   U.S. patent application Ser. No. ______, titled DISPLAY        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8512USNP3/170779-3; and    -   U.S. patent application Ser. No. ______, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney        Docket No. END8513USNP/170780.

Before explaining various aspects of surgical devices and generators indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects and/or examples.

Referring to FIG. 1, a computer-implemented interactive surgical system100 includes one or more surgical systems 102 and a cloud-based system(e.g., the cloud 104 that may include a remote server 113 coupled to astorage device 105). Each surgical system 102 includes at least onesurgical hub 106 in communication with the cloud 104 that may include aremote server 113. In one example, as illustrated in FIG. 1, thesurgical system 102 includes a visualization system 108, a roboticsystem 110, and a handheld intelligent surgical instrument 112, whichare configured to communicate with one another and/or the hub 106. Insome aspects, a surgical system 102 may include an M number of hubs 106,an N number of visualization systems 108, an O number of robotic systems110, and a P number of handheld intelligent surgical instruments 112,where M, N, O, and P are integers greater than or equal to one.

FIG. 3 depicts an example of a surgical system 102 being used to performa surgical procedure on a patient who is lying down on an operatingtable 114 in a surgical operating room 116. A robotic system 110 is usedin the surgical procedure as a part of the surgical system 102. Therobotic system 110 includes a surgeon's console 118, a patient side cart120 (surgical robot), and a surgical robotic hub 122. The patient sidecart 120 can manipulate at least one removably coupled surgical tool 117through a minimally invasive incision in the body of the patient whilethe surgeon views the surgical site through the surgeon's console 118.An image of the surgical site can be obtained by a medical imagingdevice 124, which can be manipulated by the patient side cart 120 toorient the imaging device 124. The robotic hub 122 can be used toprocess the images of the surgical site for subsequent display to thesurgeon through the surgeon's console 118.

Other types of robotic systems can be readily adapted for use with thesurgical system 102. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,339,titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud 104, and are suitable for use with the present disclosure, aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,340,titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

In various aspects, the imaging device 124 includes at least one imagesensor and one or more optical components. Suitable image sensorsinclude, but are not limited to, Charge-Coupled Device (CCD) sensors andComplementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 124 may include one or moreillumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is that portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that are from about 380 nm to about750 nm.

The invisible spectrum (i.e., the non-luminous spectrum) is that portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

In one aspect, the imaging device employs multi-spectrum monitoring todiscriminate topography and underlying structures. A multi-spectralimage is one that captures image data within specific wavelength rangesacross the electromagnetic spectrum. The wavelengths may be separated byfilters or by the use of instruments that are sensitive to particularwavelengths, including light from frequencies beyond the visible lightrange, e.g., IR and ultraviolet. Spectral imaging can allow extractionof additional information the human eye fails to capture with itsreceptors for red, green, and blue. The use of multi-spectral imaging isdescribed in greater detail under the heading “Advanced ImagingAcquisition Module” in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety. Multi-spectrum monitoring can be a useful tool in relocating asurgical field after a surgical task is completed to perform one or moreof the previously described tests on the treated tissue.

It is axiomatic that strict sterilization of the operating room andsurgical equipment is required during any surgery. The strict hygieneand sterilization conditions required in a “surgical theater,” i.e., anoperating or treatment room, necessitate the highest possible sterilityof all medical devices and equipment. Part of that sterilization processis the need to sterilize anything that comes in contact with the patientor penetrates the sterile field, including the imaging device 124 andits attachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area.

In various aspects, the visualization system 108 includes one or moreimaging sensors, one or more image processing units, one or more storagearrays, and one or more displays that are strategically arranged withrespect to the sterile field, as illustrated in FIG. 2. In one aspect,the visualization system 108 includes an interface for HL7, PACS, andEMR. Various components of the visualization system 108 are describedunder the heading “Advanced Imaging Acquisition Module” in U.S.Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

As illustrated in FIG. 2, a primary display 119 is positioned in thesterile field to be visible to an operator at the operating table 114.In addition, a visualization tower 111 is positioned outside the sterilefield. The visualization tower 111 includes a first non-sterile display107 and a second non-sterile display 109, which face away from eachother. The visualization system 108, guided by the hub 106, isconfigured to utilize the displays 107, 109, and 119 to coordinateinformation flow to operators inside and outside the sterile field. Forexample, the hub 106 may cause the visualization system 108 to display asnap-shot of a surgical site, as recorded by an imaging device 124, on anon-sterile display 107 or 109, while maintaining a live feed of thesurgical site on the primary display 119. The snap-shot on thenon-sterile display 107 or 109 can permit a non-sterile operator toperform a diagnostic step relevant to the surgical procedure, forexample.

In one aspect, the hub 106 is also configured to route a diagnosticinput or feedback entered by a non-sterile operator at the visualizationtower 111 to the primary display 119 within the sterile field, where itcan be viewed by a sterile operator at the operating table. In oneexample, the input can be in the form of a modification to the snap-shotdisplayed on the non-sterile display 107 or 109, which can be routed tothe primary display 119 by the hub 106.

Referring to FIG. 2, a surgical instrument 112 is being used in thesurgical procedure as part of the surgical system 102. The hub 106 isalso configured to coordinate information flow to a display of thesurgical instrument 112. For example, in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety. A diagnostic input or feedback entered by anon-sterile operator at the visualization tower 111 can be routed by thehub 106 to the surgical instrument display 115 within the sterile field,where it can be viewed by the operator of the surgical instrument 112.Example surgical instruments that are suitable for use with the surgicalsystem 102 are described under the heading “Surgical InstrumentHardware” and in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety, for example.

Referring now to FIG. 3, a hub 106 is depicted in communication with avisualization system 108, a robotic system 110, and a handheldintelligent surgical instrument 112. The hub 106 includes a hub display135, an imaging module 138, a generator module 140, a communicationmodule 130, a processor module 132, and a storage array 134. In certainaspects, as illustrated in FIG. 3, the hub 106 further includes a smokeevacuation module 126 and/or a suction/irrigation module 128.

During a surgical procedure, energy application to tissue, for sealingand/or cutting, is generally associated with smoke evacuation, suctionof excess fluid, and/or irrigation of the tissue. Fluid, power, and/ordata lines from different sources are often entangled during thesurgical procedure. Valuable time can be lost addressing this issueduring a surgical procedure. Detangling the lines may necessitatedisconnecting the lines from their respective modules, which may requireresetting the modules. The hub modular enclosure 136 offers a unifiedenvironment for managing the power, data, and fluid lines, which reducesthe frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in asurgical procedure that involves energy application to tissue at asurgical site. The surgical hub includes a hub enclosure and a combogenerator module slidably receivable in a docking station of the hubenclosure. The docking station includes data and power contacts. Thecombo generator module includes two or more of an ultrasonic energygenerator component, a bipolar RF energy generator component, and amonopolar RF energy generator component that are housed in a singleunit. In one aspect, the combo generator module also includes a smokeevacuation component, at least one energy delivery cable for connectingthe combo generator module to a surgical instrument, at least one smokeevacuation component configured to evacuate smoke, fluid, and/orparticulates generated by the application of therapeutic energy to thetissue, and a fluid line extending from the remote surgical site to thesmoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluidline extends from the remote surgical site to a suction and irrigationmodule slidably received in the hub enclosure. In one aspect, the hubenclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than oneenergy type to the tissue. One energy type may be more beneficial forcutting the tissue, while another different energy type may be morebeneficial for sealing the tissue. For example, a bipolar generator canbe used to seal the tissue while an ultrasonic generator can be used tocut the sealed tissue. Aspects of the present disclosure present asolution where a hub modular enclosure 136 is configured to accommodatedifferent generators, and facilitate an interactive communicationtherebetween. One of the advantages of the hub modular enclosure 136 isenabling the quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical enclosurefor use in a surgical procedure that involves energy application totissue. The modular surgical enclosure includes a first energy-generatormodule, configured to generate a first energy for application to thetissue, and a first docking station comprising a first docking port thatincludes first data and power contacts, wherein the firstenergy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts.

Further to the above, the modular surgical enclosure also includes asecond energy-generator module configured to generate a second energy,different than the first energy, for application to the tissue, and asecond docking station comprising a second docking port that includessecond data and power contacts, wherein the second energy-generatormodule is slidably movable into an electrical engagement with the powerand data contacts, and wherein the second energy-generator module isslidably movable out of the electrical engagement with the second powerand data contacts.

In addition, the modular surgical enclosure also includes acommunication bus between the first docking port and the second dockingport, configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.

Referring to FIGS. 3-7, aspects of the present disclosure are presentedfor a hub modular enclosure 136 that allows the modular integration of agenerator module 140, a smoke evacuation module 126, and asuction/irrigation module 128. The hub modular enclosure 136 furtherfacilitates interactive communication between the modules 140, 126, 128.As illustrated in FIG. 5, the generator module 140 can be a generatormodule with integrated monopolar, bipolar, and ultrasonic componentssupported in a single housing unit 139 slidably insertable into the hubmodular enclosure 136. As illustrated in FIG. 5, the generator module140 can be configured to connect to a monopolar device 146, a bipolardevice 147, and an ultrasonic device 148. Alternatively, the generatormodule 140 may comprise a series of monopolar, bipolar, and/orultrasonic generator modules that interact through the hub modularenclosure 136. The hub modular enclosure 136 can be configured tofacilitate the insertion of multiple generators and interactivecommunication between the generators docked into the hub modularenclosure 136 so that the generators would act as a single generator.

In one aspect, the hub modular enclosure 136 comprises a modular powerand communication backplane 149 with external and wireless communicationheaders to enable the removable attachment of the modules 140, 126, 128and interactive communication therebetween.

In one aspect, the hub modular enclosure 136 includes docking stations,or drawers, 151, herein also referred to as drawers, which areconfigured to slidably receive the modules 140, 126, 128. FIG. 4illustrates a partial perspective view of a surgical hub enclosure 136,and a combo generator module 145 slidably receivable in a dockingstation 151 of the surgical hub enclosure 136. A docking port 152 withpower and data contacts on a rear side of the combo generator module 145is configured to engage a corresponding docking port 150 with power anddata contacts of a corresponding docking station 151 of the hub modularenclosure 136 as the combo generator module 145 is slid into positionwithin the corresponding docking station 151 of the hub module enclosure136. In one aspect, the combo generator module 145 includes a bipolar,ultrasonic, and monopolar module and a smoke evacuation moduleintegrated together into a single housing unit 139, as illustrated inFIG. 5.

In various aspects, the smoke evacuation module 126 includes a fluidline 154 that conveys captured/collected smoke and/or fluid away from asurgical site and to, for example, the smoke evacuation module 126.Vacuum suction originating from the smoke evacuation module 126 can drawthe smoke into an opening of a utility conduit at the surgical site. Theutility conduit, coupled to the fluid line, can be in the form of aflexible tube terminating at the smoke evacuation module 126. Theutility conduit and the fluid line define a fluid path extending towardthe smoke evacuation module 126 that is received in the hub enclosure136.

In various aspects, the suction/irrigation module 128 is coupled to asurgical tool comprising an aspiration fluid line and a suction fluidline. In one example, the aspiration and suction fluid lines are in theform of flexible tubes extending from the surgical site toward thesuction/irrigation module 128. One or more drive systems can beconfigured to cause irrigation and aspiration of fluids to and from thesurgical site.

In one aspect, the surgical tool includes a shaft having an end effectorat a distal end thereof and at least one energy treatment associatedwith the end effector, an aspiration tube, and an irrigation tube. Theaspiration tube can have an inlet port at a distal end thereof and theaspiration tube extends through the shaft. Similarly, an irrigation tubecan extend through the shaft and can have an inlet port in proximity tothe energy deliver implement. The energy deliver implement is configuredto deliver ultrasonic and/or RF energy to the surgical site and iscoupled to the generator module 140 by a cable extending initiallythrough the shaft.

The irrigation tube can be in fluid communication with a fluid source,and the aspiration tube can be in fluid communication with a vacuumsource. The fluid source and/or the vacuum source can be housed in thesuction/irrigation module 128. In one example, the fluid source and/orthe vacuum source can be housed in the hub enclosure 136 separately fromthe suction/irrigation module 128. In such example, a fluid interfacecan be configured to connect the suction/irrigation module 128 to thefluid source and/or the vacuum source.

In one aspect, the modules 140, 126, 128 and/or their correspondingdocking stations on the hub modular enclosure 136 may include alignmentfeatures that are configured to align the docking ports of the modulesinto engagement with their counterparts in the docking stations of thehub modular enclosure 136. For example, as illustrated in FIG. 4, thecombo generator module 145 includes side brackets 155 that areconfigured to slidably engage with corresponding brackets 156 of thecorresponding docking station 151 of the hub modular enclosure 136. Thebrackets cooperate to guide the docking port contacts of the combogenerator module 145 into an electrical engagement with the docking portcontacts of the hub modular enclosure 136.

In some aspects, the drawers 151 of the hub modular enclosure 136 arethe same, or substantially the same size, and the modules are adjustedin size to be received in the drawers 151. For example, the sidebrackets 155 and/or 156 can be larger or smaller depending on the sizeof the module. In other aspects, the drawers 151 are different in sizeand are each designed to accommodate a particular module.

Furthermore, the contacts of a particular module can be keyed forengagement with the contacts of a particular drawer to avoid inserting amodule into a drawer with mismatching contacts.

As illustrated in FIG. 4, the docking port 150 of one drawer 151 can becoupled to the docking port 150 of another drawer 151 through acommunications link 157 to facilitate an interactive communicationbetween the modules housed in the hub modular enclosure 136. The dockingports 150 of the hub modular enclosure 136 may alternatively, oradditionally, facilitate a wireless interactive communication betweenthe modules housed in the hub modular enclosure 136. Any suitablewireless communication can be employed, such as for example AirTitan-Bluetooth.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing 160 configured toreceive a plurality of modules of a surgical hub 206. The lateralmodular housing 160 is configured to laterally receive and interconnectthe modules 161. The modules 161 are slidably inserted into dockingstations 162 of lateral modular housing 160, which includes a backplanefor interconnecting the modules 161. As illustrated in FIG. 6, themodules 161 are arranged laterally in the lateral modular housing 160.Alternatively, the modules 161 may be arranged vertically in a lateralmodular housing.

FIG. 7 illustrates a vertical modular housing 164 configured to receivea plurality of modules 165 of the surgical hub 106. The modules 165 areslidably inserted into docking stations, or drawers, 167 of verticalmodular housing 164, which includes a backplane for interconnecting themodules 165. Although the drawers 167 of the vertical modular housing164 are arranged vertically, in certain instances, a vertical modularhousing 164 may include drawers that are arranged laterally.Furthermore, the modules 165 may interact with one another through thedocking ports of the vertical modular housing 164. In the example ofFIG. 7, a display 177 is provided for displaying data relevant to theoperation of the modules 165. In addition, the vertical modular housing164 includes a master module 178 housing a plurality of sub-modules thatare slidably received in the master module 178.

In various aspects, the imaging module 138 comprises an integrated videoprocessor and a modular light source and is adapted for use with variousimaging devices. In one aspect, the imaging device is comprised of amodular housing that can be assembled with a light source module and acamera module. The housing can be a disposable housing. In at least oneexample, the disposable housing is removably coupled to a reusablecontroller, a light source module, and a camera module. The light sourcemodule and/or the camera module can be selectively chosen depending onthe type of surgical procedure. In one aspect, the camera modulecomprises a CCD sensor. In another aspect, the camera module comprises aCMOS sensor. In another aspect, the camera module is configured forscanned beam imaging. Likewise, the light source module can beconfigured to deliver a white light or a different light, depending onthe surgical procedure.

During a surgical procedure, removing a surgical device from thesurgical field and replacing it with another surgical device thatincludes a different camera or a different light source can beinefficient. Temporarily losing sight of the surgical field may lead toundesirable consequences. The module imaging device of the presentdisclosure is configured to permit the replacement of a light sourcemodule or a camera module midstream during a surgical procedure, withouthaving to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing thatincludes a plurality of channels. A first channel is configured toslidably receive the camera module, which can be configured for asnap-fit engagement with the first channel. A second channel isconfigured to slidably receive the light source module, which can beconfigured for a snap-fit engagement with the second channel. In anotherexample, the camera module and/or the light source module can be rotatedinto a final position within their respective channels. A threadedengagement can be employed in lieu of the snap-fit engagement.

In various examples, multiple imaging devices are placed at differentpositions in the surgical field to provide multiple views. The imagingmodule 138 can be configured to switch between the imaging devices toprovide an optimal view. In various aspects, the imaging module 138 canbe configured to integrate the images from the different imaging device.

Various image processors and imaging devices suitable for use with thepresent disclosure are described in U.S. Pat. No. 7,995,045, titledCOMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9,2011, which is herein incorporated by reference in its entirety. Inaddition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVALAPPARATUS AND METHOD, which issued on Jul. 19, 2011, which is hereinincorporated by reference in its entirety, describes various systems forremoving motion artifacts from image data. Such systems can beintegrated with the imaging module 138. Furthermore, U.S. PatentApplication Publication No. 2011/0306840, titled CONTROLLABLE MAGNETICSOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15,2011, and U.S. Patent Application Publication No. 2014/0243597, titledSYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, whichpublished on Aug. 28, 2014, each of which is herein incorporated byreference in its entirety.

FIG. 8 illustrates a surgical data network 201 comprising a modularcommunication hub 203 configured to connect modular devices located inone or more operating theaters of a healthcare facility, or any room ina healthcare facility specially equipped for surgical operations, to acloud-based system (e.g., the cloud 204 that may include a remote server213 coupled to a storage device 205). In one aspect, the modularcommunication hub 203 comprises a network hub 207 and/or a networkswitch 209 in communication with a network router. The modularcommunication hub 203 also can be coupled to a local computer system 210to provide local computer processing and data manipulation. The surgicaldata network 201 may be configured as passive, intelligent, orswitching. A passive surgical data network serves as a conduit for thedata, enabling it to go from one device (or segment) to another and tothe cloud computing resources. An intelligent surgical data networkincludes additional features to enable the traffic passing through thesurgical data network to be monitored and to configure each port in thenetwork hub 207 or network switch 209. An intelligent surgical datanetwork may be referred to as a manageable hub or switch. A switchinghub reads the destination address of each packet and then forwards thepacket to the correct port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 203. The network hub 207 and/or thenetwork switch 209 may be coupled to a network router 211 to connect thedevices 1 a-1 n to the cloud 204 or the local computer system 210. Dataassociated with the devices 1 a-1 n may be transferred to cloud-basedcomputers via the router for remote data processing and manipulation.Data associated with the devices 1 a-1 n may also be transferred to thelocal computer system 210 for local data processing and manipulation.Modular devices 2 a-2 m located in the same operating theater also maybe coupled to a network switch 209. The network switch 209 may becoupled to the network hub 207 and/or the network router 211 to connectto the devices 2 a-2 m to the cloud 204. Data associated with thedevices 2 a-2 n may be transferred to the cloud 204 via the networkrouter 211 for data processing and manipulation. Data associated withthe devices 2 a-2 m may also be transferred to the local computer system210 for local data processing and manipulation.

It will be appreciated that the surgical data network 201 may beexpanded by interconnecting multiple network hubs 207 and/or multiplenetwork switches 209 with multiple network routers 211. The modularcommunication hub 203 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 210 also may be contained in a modular control tower.The modular communication hub 203 is connected to a display 212 todisplay images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module 138 coupled to an endoscope, a generator module 140coupled to an energy-based surgical device, a smoke evacuation module126, a suction/irrigation module 128, a communication module 130, aprocessor module 132, a storage array 134, a surgical device coupled toa display, and/or a non-contact sensor module, among other modulardevices that may be connected to the modular communication hub 203 ofthe surgical data network 201.

In one aspect, the surgical data network 201 may comprise a combinationof network hub(s), network switch(es), and network router(s) connectingthe devices 1 a-1 n/2 a-2 m to the cloud. Any one of or all of thedevices 1 a-1 n/2 a-2 m coupled to the network hub or network switch maycollect data in real time and transfer the data to cloud computers fordata processing and manipulation. It will be appreciated that cloudcomputing relies on sharing computing resources rather than having localservers or personal devices to handle software applications. The word“cloud” may be used as a metaphor for “the Internet,” although the termis not limited as such. Accordingly, the term “cloud computing” may beused herein to refer to “a type of Internet-based computing,” wheredifferent services—such as servers, storage, and applications—aredelivered to the modular communication hub 203 and/or computer system210 located in the surgical theater (e.g., a fixed, mobile, temporary,or field operating room or space) and to devices connected to themodular communication hub 203 and/or computer system 210 through theInternet. The cloud infrastructure may be maintained by a cloud serviceprovider. In this context, the cloud service provider may be the entitythat coordinates the usage and control of the devices 1 a-1 n/2 a-2 mlocated in one or more operating theaters. The cloud computing servicescan perform a large number of calculations based on the data gathered bysmart surgical instruments, robots, and other computerized deviceslocated in the operating theater. The hub hardware enables multipledevices or connections to be connected to a computer that communicateswith the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network providesimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This includes localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloud 204or the local computer system 210 or both for data processing andmanipulation including image processing and manipulation. The data maybe analyzed to improve surgical procedure outcomes by determining iffurther treatment, such as the application of endoscopic intervention,emerging technologies, a targeted radiation, targeted intervention, andprecise robotics to tissue-specific sites and conditions, may bepursued. Such data analysis may further employ outcome analyticsprocessing, and using standardized approaches may provide beneficialfeedback to either confirm surgical treatments and the behavior of thesurgeon or suggest modifications to surgical treatments and the behaviorof the surgeon.

In one implementation, the operating theater devices 1 a-1 n may beconnected to the modular communication hub 203 over a wired channel or awireless channel depending on the configuration of the devices 1 a-1 nto a network hub. The network hub 207 may be implemented, in one aspect,as a local network broadcast device that works on the physical layer ofthe Open System Interconnection (OSI) model. The network hub providesconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 207 collects data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 207 does not store any media access control/internet protocol(MAC/IP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 207. The network hub 207has no routing tables or intelligence regarding where to sendinformation and broadcasts all network data across each connection andto a remote server 213 (FIG. 9) over the cloud 204. The network hub 207can detect basic network errors such as collisions, but having allinformation broadcast to multiple ports can be a security risk and causebottlenecks.

In another implementation, the operating theater devices 2 a-2 m may beconnected to a network switch 209 over a wired channel or a wirelesschannel. The network switch 209 works in the data link layer of the OSImodel. The network switch 209 is a multicast device for connecting thedevices 2 a-2 m located in the same operating theater to the network.The network switch 209 sends data in the form of frames to the networkrouter 211 and works in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 209. The networkswitch 209 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 207 and/or the network switch 209 are coupled to thenetwork router 211 for connection to the cloud 204. The network router211 works in the network layer of the OSI model. The network router 211creates a route for transmitting data packets received from the networkhub 207 and/or network switch 211 to cloud-based computer resources forfurther processing and manipulation of the data collected by any one ofor all the devices 1 a-1 n/2 a-2 m. The network router 211 may beemployed to connect two or more different networks located in differentlocations, such as, for example, different operating theaters of thesame healthcare facility or different networks located in differentoperating theaters of different healthcare facilities. The networkrouter 211 sends data in the form of packets to the cloud 204 and worksin full duplex mode. Multiple devices can send data at the same time.The network router 211 uses IP addresses to transfer data.

In one example, the network hub 207 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 207 may include wired or wireless capabilitiesto receive information over a wired channel or a wireless channel. Inone aspect, a wireless USB short-range, high-bandwidth wireless radiocommunication protocol may be employed for communication between thedevices la-1 n and devices 2 a-2 m located in the operating theater.

In other examples, the operating theater devices 1 a-1 n/2 a-2 m maycommunicate to the modular communication hub 203 via Bluetooth wirelesstechnology standard for exchanging data over short distances (usingshort-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz)from fixed and mobile devices and building personal area networks(PANs). In other aspects, the operating theater devices 1 a-1 n/2 a-2 mmay communicate to the modular communication hub 203 via a number ofwireless or wired communication standards or protocols, including butnot limited to W-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family),IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivativesthereof, as well as any other wireless and wired protocols that aredesignated as 3G, 4G, 5G, and beyond. The computing module may include aplurality of communication modules. For instance, a first communicationmodule may be dedicated to shorter-range wireless communications such asWi-Fi and Bluetooth, and a second communication module may be dedicatedto longer-range wireless communications such as GPS, EDGE, GPRS, CDMA,WiMAX, LTE, Ev-DO, and others.

The modular communication hub 203 may serve as a central connection forone or all of the operating theater devices 1 a-1 n/2 a-2 m and handlesa data type known as frames. Frames carry the data generated by thedevices 1 a-1 n/2 a-2 m. When a frame is received by the modularcommunication hub 203, it is amplified and transmitted to the networkrouter 211, which transfers the data to the cloud computing resources byusing a number of wireless or wired communication standards orprotocols, as described herein.

The modular communication hub 203 can be used as a standalone device orbe connected to compatible network hubs and network switches to form alarger network. The modular communication hub 203 is generally easy toinstall, configure, and maintain, making it a good option for networkingthe operating theater devices 1 a-1 n/2 a-2 m.

FIG. 9 illustrates a computer-implemented interactive surgical system200. The computer-implemented interactive surgical system 200 is similarin many respects to the computer-implemented interactive surgical system100. For example, the computer-implemented interactive surgical system200 includes one or more surgical systems 202, which are similar in manyrespects to the surgical systems 102. Each surgical system 202 includesat least one surgical hub 206 in communication with a cloud 204 that mayinclude a remote server 213. In one aspect, the computer-implementedinteractive surgical system 200 comprises a modular control tower 236connected to multiple operating theater devices such as, for example,intelligent surgical instruments, robots, and other computerized deviceslocated in the operating theater. As shown in FIG. 10, the modularcontrol tower 236 comprises a modular communication hub 203 coupled to acomputer system 210. As illustrated in the example of FIG. 9, themodular control tower 236 is coupled to an imaging module 238 that iscoupled to an endoscope 239, a generator module 240 that is coupled toan energy device 241, a smoke evacuator module 226, a suction/irrigationmodule 228, a communication module 230, a processor module 232, astorage array 234, a smart device/instrument 235 optionally coupled to adisplay 237, and a non-contact sensor module 242. The operating theaterdevices are coupled to cloud computing resources and data storage viathe modular control tower 236. A robot hub 222 also may be connected tothe modular control tower 236 and to the cloud computing resources. Thedevices/instruments 235, visualization systems 208, among others, may becoupled to the modular control tower 236 via wired or wirelesscommunication standards or protocols, as described herein. The modularcontrol tower 236 may be coupled to a hub display 215 (e.g., monitor,screen) to display and overlay images received from the imaging module,device/instrument display, and/or other visualization systems 208. Thehub display also may display data received from devices connected to themodular control tower in conjunction with images and overlaid images.

FIG. 10 illustrates a surgical hub 206 comprising a plurality of modulescoupled to the modular control tower 236. The modular control tower 236comprises a modular communication hub 203, e.g., a network connectivitydevice, and a computer system 210 to provide local processing,visualization, and imaging, for example. As shown in FIG. 10, themodular communication hub 203 may be connected in a tiered configurationto expand the number of modules (e.g., devices) that may be connected tothe modular communication hub 203 and transfer data associated with themodules to the computer system 210, cloud computing resources, or both.As shown in FIG. 10, each of the network hubs/switches in the modularcommunication hub 203 includes three downstream ports and one upstreamport. The upstream network hub/switch is connected to a processor toprovide a communication connection to the cloud computing resources anda local display 217. Communication to the cloud 204 may be made eitherthrough a wired or a wireless communication channel.

The surgical hub 206 employs a non-contact sensor module 242 to measurethe dimensions of the operating theater and generate a map of thesurgical theater using either ultrasonic or laser-type non-contactmeasurement devices. An ultrasound-based non-contact sensor module scansthe operating theater by transmitting a burst of ultrasound andreceiving the echo when it bounces off the perimeter walls of anoperating theater as described under the heading “Surgical Hub SpatialAwareness Within an Operating Room” in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is herein incorporated by reference in itsentirety, in which the sensor module is configured to determine the sizeof the operating theater and to adjust Bluetooth-pairing distancelimits. A laser-based non-contact sensor module scans the operatingtheater by transmitting laser light pulses, receiving laser light pulsesthat bounce off the perimeter walls of the operating theater, andcomparing the phase of the transmitted pulse to the received pulse todetermine the size of the operating theater and to adjust Bluetoothpairing distance limits, for example.

The computer system 210 comprises a processor 244 and a networkinterface 245. The processor 244 is coupled to a communication module247, storage 248, memory 249, non-volatile memory 250, and input/outputinterface 251 via a system bus. The system bus can be any of severaltypes of bus structure(s) including the memory bus or memory controller,a peripheral bus or external bus, and/or a local bus using any varietyof available bus architectures including, but not limited to, 9-bit bus,Industrial Standard Architecture (ISA), Micro-Charmel Architecture(MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESALocal Bus (VLB), Peripheral Component Interconnect (PCI), USB, AdvancedGraphics Port (AGP), Personal Computer Memory Card InternationalAssociation bus (PCMCIA), Small Computer Systems Interface (SCSI), orany other proprietary bus.

The processor 244 may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In one aspect, the processor 244 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The system memory includes volatile memory and non-volatile memory. Thebasic input/output system (BIOS), containing the basic routines totransfer information between elements within the computer system, suchas during start-up, is stored in non-volatile memory. For example, thenon-volatile memory can include ROM, programmable ROM (PROM),electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatilememory includes random-access memory (RAM), which acts as external cachememory. Moreover, RAM is available in many forms such as SRAM, dynamicRAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and directRambus RAM (DRRAM).

The computer system 210 also includes removable/non-removable,volatile/non-volatile computer storage media, such as for example diskstorage. The disk storage includes, but is not limited to, devices likea magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zipdrive, LS-60 drive, flash memory card, or memory stick. In addition, thedisk storage can include storage media separately or in combination withother storage media including, but not limited to, an optical disc drivesuch as a compact disc ROM device (CD-ROM), compact disc recordabledrive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or adigital versatile disc ROM drive (DVD-ROM). To facilitate the connectionof the disk storage devices to the system bus, a removable ornon-removable interface may be employed.

It is to be appreciated that the computer system 210 includes softwarethat acts as an intermediary between users and the basic computerresources described in a suitable operating environment. Such softwareincludes an operating system. The operating system, which can be storedon the disk storage, acts to control and allocate resources of thecomputer system. System applications take advantage of the management ofresources by the operating system through program modules and programdata stored either in the system memory or on the disk storage. It is tobe appreciated that various components described herein can beimplemented with various operating systems or combinations of operatingsystems.

A user enters commands or information into the computer system 210through input device(s) coupled to the I/O interface 251. The inputdevices include, but are not limited to, a pointing device such as amouse, trackball, stylus, touch pad, keyboard, microphone, joystick,game pad, satellite dish, scanner, TV tuner card, digital camera,digital video camera, web camera, and the like. These and other inputdevices connect to the processor through the system bus via interfaceport(s). The interface port(s) include, for example, a serial port, aparallel port, a game port, and a USB. The output device(s) use some ofthe same types of ports as input device(s). Thus, for example, a USBport may be used to provide input to the computer system and to outputinformation from the computer system to an output device. An outputadapter is provided to illustrate that there are some output deviceslike monitors, displays, speakers, and printers, among other outputdevices that require special adapters. The output adapters include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), provide both input and output capabilities.

The computer system 210 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) is logically connected to the computer system througha network interface and then physically connected via a communicationconnection. The network interface encompasses communication networkssuch as local area networks (LANs) and wide area networks (WANs). LANtechnologies include Fiber Distributed Data Interface (FDDI), CopperDistributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE802.5 and the like. WAN technologies include, but are not limited to,point-to-point links, circuit-switching networks like IntegratedServices Digital Networks (ISDN) and variations thereon,packet-switching networks, and Digital Subscriber Lines (DSL).

In various aspects, the computer system 210 of FIG. 10, the imagingmodule 238 and/or visualization system 208, and/or the processor module232 of FIGS. 9-10, may comprise an image processor, image processingengine, media processor, or any specialized digital signal processor(DSP) used for the processing of digital images. The image processor mayemploy parallel computing with single instruction, multiple data (SIMD)or multiple instruction, multiple data (MIMD) technologies to increasespeed and efficiency. The digital image processing engine can perform arange of tasks. The image processor may be a system on a chip withmulticore processor architecture.

The communication connection(s) refers to the hardware/software employedto connect the network interface to the bus. While the communicationconnection is shown for illustrative clarity inside the computer system,it can also be external to the computer system 210. Thehardware/software necessary for connection to the network interfaceincludes, for illustrative purposes only, internal and externaltechnologies such as modems, including regular telephone-grade modems,cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

FIG. 11 illustrates a functional block diagram of one aspect of a USBnetwork hub 300 device, according to one aspect of the presentdisclosure. In the illustrated aspect, the USB network hub device 300employs a TUSB2036 integrated circuit hub by Texas Instruments. The USBnetwork hub 300 is a CMOS device that provides an upstream USBtransceiver port 302 and up to three downstream USB transceiver ports304, 306, 308 in compliance with the USB 2.0 specification. The upstreamUSB transceiver port 302 is a differential root data port comprising adifferential data minus (DM0) input paired with a differential data plus(DP0) input. The three downstream USB transceiver ports 304, 306, 308are differential data ports where each port includes differential dataplus (DP1-DP3) outputs paired with differential data minus (DM1-DM3)outputs.

The USB network hub 300 device is implemented with a digital statemachine instead of a microcontroller, and no firmware programming isrequired. Fully compliant USB transceivers are integrated into thecircuit for the upstream USB transceiver port 302 and all downstream USBtransceiver ports 304, 306, 308. The downstream USB transceiver ports304, 306, 308 support both full-speed and low-speed devices byautomatically setting the slew rate according to the speed of the deviceattached to the ports. The USB network hub 300 device may be configuredeither in bus-powered or self-powered mode and includes a hub powerlogic 312 to manage power.

The USB network hub 300 device includes a serial interface engine 310(SIE). The SIE 310 is the front end of the USB network hub 300 hardwareand handles most of the protocol described in chapter 8 of the USBspecification. The SIE 310 typically comprehends signaling up to thetransaction level. The functions that it handles could include: packetrecognition, transaction sequencing, SOP, EOP, RESET, and RESUME signaldetection/generation, clock/data separation, non-return-to-zero invert(NRZI) data encoding/decoding and bit-stuffing, CRC generation andchecking (token and data), packet ID (PID) generation andchecking/decoding, and/or serial-parallel/parallel-serial conversion.The 310 receives a clock input 314 and is coupled to a suspend/resumelogic and frame timer 316 circuit and a hub repeater circuit 318 tocontrol communication between the upstream USB transceiver port 302 andthe downstream USB transceiver ports 304, 306, 308 through port logiccircuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326via interface logic to control commands from a serial EEPROM via aserial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functionsconfigured in up to six logical layers (tiers) to a single computer.Further, the USB network hub 300 can connect to all peripherals using astandardized four-wire cable that provides both communication and powerdistribution. The power configurations are bus-powered and self-poweredmodes. The USB network hub 300 may be configured to support four modesof power management: a bus-powered hub, with either individual-portpower management or ganged-port power management, and the self-poweredhub, with either individual-port power management or ganged-port powermanagement. In one aspect, using a USB cable, the USB network hub 300,the upstream USB transceiver port 302 is plugged into a USB hostcontroller, and the downstream USB transceiver ports 304, 306, 308 areexposed for connecting USB compatible devices, and so forth.

SURGICAL INSTRUMENT HARDWARE

FIG. 12 illustrates a logic diagram of a control system 470 of asurgical instrument or tool in accordance with one or more aspects ofthe present disclosure. The system 470 comprises a control circuit. Thecontrol circuit includes a microcontroller 461 comprising a processor462 and a memory 468. One or more of sensors 472, 474, 476, for example,provide real-time feedback to the processor 462. A motor 482, driven bya motor driver 492, operably couples a longitudinally movabledisplacement member to drive the I-beam knife element. A tracking system480 is configured to determine the position of the longitudinallymovable displacement member. The position information is provided to theprocessor 462, which can be programmed or configured to determine theposition of the longitudinally movable drive member as well as theposition of a firing member, firing bar, and I-beam knife element.Additional motors may be provided at the tool driver interface tocontrol I-beam firing, closure tube travel, shaft rotation, andarticulation. A display 473 displays a variety of operating conditionsof the instruments and may include touch screen functionality for datainput. Information displayed on the display 473 may be overlaid withimages acquired via endoscopic imaging modules.

In one aspect, the microcontroller 461 may be any single-core ormulticore processor such as those known under the trade name ARM Cortexby Texas Instruments. In one aspect, the main microcontroller 461 may bean LM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare® software,a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/orone or more 12-bit ADCs with 12 analog input channels, details of whichare available for the product datasheet.

In one aspect, the microcontroller 461 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 461 may be programmed to perform various functionssuch as precise control over the speed and position of the knife andarticulation systems. In one aspect, the microcontroller 461 includes aprocessor 462 and a memory 468. The electric motor 482 may be a brusheddirect current (DC) motor with a gearbox and mechanical links to anarticulation or knife system. In one aspect, a motor driver 492 may bean A3941 available from Allegro Microsystems, Inc. Other motor driversmay be readily substituted for use in the tracking system 480 comprisingan absolute positioning system. A detailed description of an absolutepositioning system is described in U.S. Patent Application PublicationNo. 2017/0296213, titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICALSTAPLING AND CUTTING INSTRUMENT, which published on Oct. 19, 2017, whichis herein incorporated by reference in its entirety.

The microcontroller 461 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 461 may be configured to compute a responsein the software of the microcontroller 461. The computed response iscompared to a measured response of the actual system to obtain an“observed” response, which is used for actual feedback decisions. Theobserved response is a favorable, tuned value that balances the smooth,continuous nature of the simulated response with the measured response,which can detect outside influences on the system.

In one aspect, the motor 482 may be controlled by the motor driver 492and can be employed by the firing system of the surgical instrument ortool. In various forms, the motor 482 may be a brushed DC driving motorhaving a maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 482 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 492 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 482can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery which mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable. In at least one example, the batterycells can be lithium-ion batteries which can be couplable to andseparable from the power assembly.

The motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. The A3941 492 is a full-bridge controller for usewith external N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 492 comprises a unique charge pump regulatorthat provides full (>10 V) gate drive for battery voltages down to 7 Vand allows the A3941 to operate with a reduced gate drive, down to 5.5V. A bootstrap capacitor may be employed to provide the above batterysupply voltage required for N-channel MOSFETs. An internal charge pumpfor the high-side drive allows DC (100% duty cycle) operation. The fullbridge can be driven in fast or slow decay modes using diode orsynchronous rectification. In the slow decay mode, current recirculationcan be through the high-side or the lowside FETs. The power FETs areprotected from shoot-through by resistor-adjustable dead time.Integrated diagnostics provide indications of undervoltage,overtemperature, and power bridge faults and can be configured toprotect the power MOSFETs under most short circuit conditions. Othermotor drivers may be readily substituted for use in the tracking system480 comprising an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuitarrangement comprising a position sensor 472 according to one aspect ofthis disclosure. The position sensor 472 for an absolute positioningsystem provides a unique position signal corresponding to the locationof a displacement member. In one aspect, the displacement memberrepresents a longitudinally movable drive member comprising a rack ofdrive teeth for meshing engagement with a corresponding drive gear of agear reducer assembly. In other aspects, the displacement memberrepresents the firing member, which could be adapted and configured toinclude a rack of drive teeth. In yet another aspect, the displacementmember represents a firing bar or the I-beam, each of which can beadapted and configured to include a rack of drive teeth. Accordingly, asused herein, the term displacement member is used generically to referto any movable member of the surgical instrument or tool such as thedrive member, the firing member, the firing bar, the I-beam, or anyelement that can be displaced. In one aspect, the longitudinally movabledrive member is coupled to the firing member, the firing bar, and theI-beam. Accordingly, the absolute positioning system can, in effect,track the linear displacement of the I-beam by tracking the lineardisplacement of the longitudinally movable drive member. In variousother aspects, the displacement member may be coupled to any positionsensor 472 suitable for measuring linear displacement. Thus, thelongitudinally movable drive member, the firing member, the firing bar,or the I-beam, or combinations thereof, may be coupled to any suitablelinear displacement sensor. Linear displacement sensors may includecontact or non-contact displacement sensors. Linear displacement sensorsmay comprise linear variable differential transformers (LVDT),differential variable reluctance transducers (DVRT), a slidepotentiometer, a magnetic sensing system comprising a movable magnet anda series of linearly arranged Hall effect sensors, a magnetic sensingsystem comprising a fixed magnet and a series of movable, linearlyarranged Hall effect sensors, an optical sensing system comprising amovable light source and a series of linearly arranged photo diodes orphoto detectors, an optical sensing system comprising a fixed lightsource and a series of movable linearly, arranged photo diodes or photodetectors, or any combination thereof.

The electric motor 482 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack, of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 472 element corresponds to some linearlongitudinal translation of the displacement member. An arrangement ofgearing and sensors can be connected to the linear actuator, via a rackand pinion arrangement, or a rotary actuator, via a spur gear or otherconnection. A power source supplies power to the absolute positioningsystem and an output indicator may display the output of the absolutepositioning system. The displacement member represents thelongitudinally movable drive member comprising a rack of drive teethformed thereon for meshing engagement with a corresponding drive gear ofthe gear reducer assembly. The displacement member represents thelongitudinally movable firing member, firing bar, I-beam, orcombinations thereof.

A single revolution of the sensor element associated with the positionsensor 472 is equivalent to a longitudinal linear displacement d1 of theof the displacement member, where d1 is the longitudinal linear distancethat the displacement member moves from point “a” to point “b” after asingle revolution of the sensor element coupled to the displacementmember. The sensor arrangement may be connected via a gear reductionthat results in the position sensor 472 completing one or morerevolutions for the full stroke of the displacement member. The positionsensor 472 may complete multiple revolutions for the full stroke of thedisplacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 472. The state of the switches are fed back to themicrocontroller 461 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d1+d2+. . .dn of the displacement member. The output of the position sensor 472 isprovided to the microcontroller 461. The position sensor 472 of thesensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 472 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic,and microelectromechanical systems-based magnetic sensors, among others.

In one aspect, the position sensor 472 for the tracking system 480comprising an absolute positioning system comprises a magnetic rotaryabsolute positioning system. The position sensor 472 may be implementedas an AS5055EQFT single-chip magnetic rotary position sensor availablefrom Austria Microsystems, AG. The position sensor 472 is interfacedwith the microcontroller 461 to provide an absolute positioning system.The position sensor 472 is a low-voltage and low-power component andincludes four Hall-effect elements in an area of the position sensor 472that is located above a magnet. A high-resolution ADC and a smart powermanagement controller are also provided on the chip. A coordinaterotation digital computer (CORDIC) processor, also known as thedigit-by-digit method and Volder's algorithm, is provided to implement asimple and efficient algorithm to calculate hyperbolic and trigonometricfunctions that require only addition, subtraction, bitshift, and tablelookup operations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface, such as a serial peripheral interface (SPI) interface, to themicrocontroller 461. The position sensor 472 provides 12 or 14 bits ofresolution. The position sensor 472 may be an AS5055 chip provided in asmall QFN 16-pin 4×4×0.85 mm package.

The tracking system 480 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 472. In some aspects, the othersensor(s) can include sensor arrangements such as those described inU.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM, which issued on May 24, 2016, which is herein incorporated byreference in its entirety; U.S. Patent Application Publication No.2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which published on Sep. 18, 2014, which is herein incorporated byreference in its entirety; and U.S. patent application Ser. No.15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OFA SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, whichis herein incorporated by reference in its entirety. In a digital signalprocessing system, an absolute positioning system is coupled to adigital data acquisition system where the output of the absolutepositioning system will have a finite resolution and sampling frequency.The absolute positioning system may comprise a compare-and-combinecircuit to combine a computed response with a measured response usingalgorithms, such as a weighted average and a theoretical control loop,that drive the computed response towards the measured response. Thecomputed response of the physical system takes into account propertieslike mass, inertial, viscous friction, inductance resistance, etc., topredict what the states and outputs of the physical system will be byknowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 482 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 474, such as, for example, a strain gauge or a micro-straingauge, is configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain is converted toa digital signal and provided to the processor 462. Alternatively, or inaddition to the sensor 474, a sensor 476, such as, for example, a loadsensor, can measure the closure force applied by the closure drivesystem to the anvil. The sensor 476, such as, for example, a loadsensor, can measure the firing force applied to an I-beam in a firingstroke of the surgical instrument or tool. The I-beam is configured toengage a wedge sled, which is configured to upwardly cam staple driversto force out staples into deforming contact with an anvil. The I-beamalso includes a sharpened cutting edge that can be used to sever tissueas the I-beam is advanced distally by the firing bar. Alternatively, acurrent sensor 478 can be employed to measure the current drawn by themotor 482. The force required to advance the firing member cancorrespond to the current drawn by the motor 482, for example. Themeasured force is converted to a digital signal and provided to theprocessor 462.

In one form, the strain gauge sensor 474 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector comprises a strain gauge sensor474, such as, for example, a micro-strain gauge, that is configured tomeasure one or more parameters of the end effector, for example. In oneaspect, the strain gauge sensor 474 can measure the amplitude ormagnitude of the strain exerted on a jaw member of an end effectorduring a clamping operation, which can be indicative of the tissuecompression. The measured strain is converted to a digital signal andprovided to a processor 462 of the microcontroller 461. A load sensor476 can measure the force used to operate the knife element, forexample, to cut the tissue captured between the anvil and the staplecartridge. A magnetic field sensor can be employed to measure thethickness of the captured tissue. The measurement of the magnetic fieldsensor also may be converted to a digital signal and provided to theprocessor 462.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 474, 476, can be used by themicrocontroller 461 to characterize the selected position of the firingmember and/or the corresponding value of the speed of the firing member.In one instance, a memory 468 may store a technique, an equation, and/ora lookup table which can be employed by the microcontroller 461 in theassessment.

The control system 470 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub as shown in FIGS. 8-11.

FIG. 13 illustrates a control circuit 500 configured to control aspectsof the surgical instrument or tool according to one aspect of thisdisclosure. The control circuit 500 can be configured to implementvarious processes described herein. The control circuit 500 may comprisea microcontroller comprising one or more processors 502 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit504. The memory circuit 504 stores machine-executable instructions that,when executed by the processor 502, cause the processor 502 to executemachine instructions to implement various processes described herein.The processor 502 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 504 may comprisevolatile and non-volatile storage media. The processor 502 may includean instruction processing unit 506 and an arithmetic unit 508. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 504 of this disclosure.

FIG. 14 illustrates a combinational logic circuit 510 configured tocontrol aspects of the surgical instrument or tool according to oneaspect of this disclosure. The combinational logic circuit 510 can beconfigured to implement various processes described herein. Thecombinational logic circuit 510 may comprise a finite state machinecomprising a combinational logic 512 configured to receive dataassociated with the surgical instrument or tool at an input 514, processthe data by the combinational logic 512, and provide an output 516.

FIG. 15 illustrates a sequential logic circuit 520 configured to controlaspects of the surgical instrument or tool according to one aspect ofthis disclosure. The sequential logic circuit 520 or the combinationallogic 522 can be configured to implement various processes describedherein. The sequential logic circuit 520 may comprise a finite statemachine. The sequential logic circuit 520 may comprise a combinationallogic 522, at least one memory circuit 524, and a clock 529, forexample. The at least one memory circuit 524 can store a current stateof the finite state machine. In certain instances, the sequential logiccircuit 520 may be synchronous or asynchronous. The combinational logic522 is configured to receive data associated with the surgicalinstrument or tool from an input 526, process the data by thecombinational logic 522, and provide an output 528. In other aspects,the circuit may comprise a combination of a processor (e.g., processor502, FIG. 13) and a finite state machine to implement various processesherein. In other aspects, the finite state machine may comprise acombination of a combinational logic circuit (e.g., combinational logiccircuit 510, FIG. 14) and the sequential logic circuit 520.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions. Incertain instances, a first motor can be activated to perform a firstfunction, a second motor can be activated to perform a second function,a third motor can be activated to perform a third function, a fourthmotor can be activated to perform a fourth function, and so on. Incertain instances, the plurality of motors of robotic surgicalinstrument 600 can be individually activated to cause firing, closure,and/or articulation motions in the end effector. The firing, closure,and/or articulation motions can be transmitted to the end effectorthrough a shaft assembly, for example.

In certain instances, the surgical instrument system or tool may includea firing motor 602. The firing motor 602 may be operably coupled to afiring motor drive assembly 604 which can be configured to transmitfiring motions, generated by the motor 602 to the end effector, inparticular to displace the I-beam element. In certain instances, thefiring motions generated by the motor 602 may cause the staples to bedeployed from the staple cartridge into tissue captured by the endeffector and/or the cutting edge of the I-beam element to be advanced tocut the captured tissue, for example. The I-beam element may beretracted by reversing the direction of the motor 602.

In certain instances, the surgical instrument or tool may include aclosure motor 603. The closure motor 603 may be operably coupled to aclosure motor drive assembly 605 which can be configured to transmitclosure motions, generated by the motor 603 to the end effector, inparticular to displace a closure tube to close the anvil and compresstissue between the anvil and the staple cartridge. The closure motionsmay cause the end effector to transition from an open configuration toan approximated configuration to capture tissue, for example. The endeffector may be transitioned to an open position by reversing thedirection of the motor 603.

In certain instances, the surgical instrument or tool may include one ormore articulation motors 606 a, 606 b, for example. The motors 606 a,606 b may be operably coupled to respective articulation motor driveassemblies 608 a, 608 b, which can be configured to transmitarticulation motions generated by the motors 606 a, 606 b to the endeffector. In certain instances, the articulation motions may cause theend effector to articulate relative to the shaft, for example.

As described above, the surgical instrument or tool may include aplurality of motors which may be configured to perform variousindependent functions. In certain instances, the plurality of motors ofthe surgical instrument or tool can be individually or separatelyactivated to perform one or more functions while the other motors remaininactive. For example, the articulation motors 606 a, 606 b can beactivated to cause the end effector to be articulated while the firingmotor 602 remains inactive. Alternatively, the firing motor 602 can beactivated to fire the plurality of staples, and/or to advance thecutting edge, while the articulation motor 606 remains inactive.Furthermore the closure motor 603 may be activated simultaneously withthe firing motor 602 to cause the closure tube and the I-beam element toadvance distally as described in more detail hereinbelow.

In certain instances, the surgical instrument or tool may include acommon control module 610 which can be employed with a plurality ofmotors of the surgical instrument or tool. In certain instances, thecommon control module 610 may accommodate one of the plurality of motorsat a time. For example, the common control module 610 can be couplableto and separable from the plurality of motors of the robotic surgicalinstrument individually. In certain instances, a plurality of the motorsof the surgical instrument or tool may share one or more common controlmodules such as the common control module 610. In certain instances, aplurality of motors of the surgical instrument or tool can beindividually and selectively engaged with the common control module 610.In certain instances, the common control module 610 can be selectivelyswitched from interfacing with one of a plurality of motors of thesurgical instrument or tool to interfacing with another one of theplurality of motors of the surgical instrument or tool.

In at least one example, the common control module 610 can beselectively switched between operable engagement with the articulationmotors 606 a, 606 b and operable engagement with either the firing motor602 or the closure motor 603. In at least one example, as illustrated inFIG. 16, a switch 614 can be moved or transitioned between a pluralityof positions and/or states. In a first position 616, the switch 614 mayelectrically couple the common control module 610 to the firing motor602; in a second position 617, the switch 614 may electrically couplethe common control module 610 to the closure motor 603; in a thirdposition 618 a, the switch 614 may electrically couple the commoncontrol module 610 to the first articulation motor 606 a; and in afourth position 618 b, the switch 614 may electrically couple the commoncontrol module 610 to the second articulation motor 606 b, for example.In certain instances, separate common control modules 610 can beelectrically coupled to the firing motor 602, the closure motor 603, andthe articulations motor 606 a, 606 b at the same time. In certaininstances, the switch 614 may be a mechanical switch, anelectromechanical switch, a solid-state switch, or any suitableswitching mechanism.

Each of the motors 602, 603, 606 a, 606 b may comprise a torque sensorto measure the output torque on the shaft of the motor. The force on anend effector may be sensed in any conventional manner, such as by forcesensors on the outer sides of the jaws or by a torque sensor for themotor actuating the jaws.

In various instances, as illustrated in FIG. 16, the common controlmodule 610 may comprise a motor driver 626 which may comprise one ormore H-Bridge FETs. The motor driver 626 may modulate the powertransmitted from a power source 628 to a motor coupled to the commoncontrol module 610 based on input from a microcontroller 620 (the“controller”), for example. In certain instances, the microcontroller620 can be employed to determine the current drawn by the motor, forexample, while the motor is coupled to the common control module 610, asdescribed above.

In certain instances, the microcontroller 620 may include amicroprocessor 622 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 624 (the “memory”). In certaininstances, the memory 624 may store various program instructions, whichwhen executed may cause the processor 622 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 624 may be coupled to the processor 622,for example.

In certain instances, the power source 628 can be employed to supplypower to the microcontroller 620, for example. In certain instances, thepower source 628 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source628. In certain instances, the power source 628 may be replaceableand/or rechargeable, for example.

In various instances, the processor 622 may control the motor driver 626to control the position, direction of rotation, and/or velocity of amotor that is coupled to the common control module 610. In certaininstances, the processor 622 can signal the motor driver 626 to stopand/or disable a motor that is coupled to the common control module 610.It should be understood that the term “processor” as used hereinincludes any suitable microprocessor, microcontroller, or other basiccomputing device that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 622 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the module 4410. Accordingly, the present disclosure should notbe limited in this context.

In certain instances, the memory 624 may include program instructionsfor controlling each of the motors of the surgical instrument 600 thatare couplable to the common control module 610. For example, the memory624 may include program instructions for controlling the firing motor602, the closure motor 603, and the articulation motors 606 a, 606 b.Such program instructions may cause the processor 622 to control thefiring, closure, and articulation functions in accordance with inputsfrom algorithms or control programs of the surgical instrument or tool.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 630 can be employed to alert the processor 622 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 630 may alert the processor 622 to use the programinstructions associated with firing, closing, and articulating the endeffector. In certain instances, the sensors 630 may comprise positionsensors which can be employed to sense the position of the switch 614,for example. Accordingly, the processor 622 may use the programinstructions associated with firing the I-beam of the end effector upondetecting, through the sensors 630 for example, that the switch 614 isin the first position 616; the processor 622 may use the programinstructions associated with closing the anvil upon detecting, throughthe sensors 630 for example, that the switch 614 is in the secondposition 617; and the processor 622 may use the program instructionsassociated with articulating the end effector upon detecting, throughthe sensors 630 for example, that the switch 614 is in the third orfourth position 618 a, 618 b.

FIG. 17 is a schematic diagram of a robotic surgical instrument 700configured to operate a surgical tool described herein according to oneaspect of this disclosure. The robotic surgical instrument 700 may beprogrammed or configured to control distal/proximal translation of adisplacement member, distal/proximal displacement of a closure tube,shaft rotation, and articulation, either with single or multiplearticulation drive links. In one aspect, the surgical instrument 700 maybe programmed or configured to individually control a firing member, aclosure member, a shaft member, and/or one or more articulation members.The surgical instrument 700 comprises a control circuit 710 configuredto control motor-driven firing members, closure members, shaft members,and/or one or more articulation members.

In one aspect, the robotic surgical instrument 700 comprises a controlcircuit 710 configured to control an anvil 716 and an I-beam 714(including a sharp cutting edge) portion of an end effector 702, aremovable staple cartridge 718, a shaft 740, and one or morearticulation members 742 a, 742 b via a plurality of motors 704 a-704 e.A position sensor 734 may be configured to provide position feedback ofthe I-beam 714 to the control circuit 710. Other sensors 738 may beconfigured to provide feedback to the control circuit 710. Atimer/counter 731 provides timing and counting information to thecontrol circuit 710. An energy source 712 may be provided to operate themotors 704 a-704 e, and a current sensor 736 provides motor currentfeedback to the control circuit 710. The motors 704 a-704 e can beoperated individually by the control circuit 710 in a open-loop orclosed-loop feedback control.

In one aspect, the control circuit 710 may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to performone or more tasks. In one aspect, a timer/counter 731 provides an outputsignal, such as the elapsed time or a digital count, to the controlcircuit 710 to correlate the position of the I-beam 714 as determined bythe position sensor 734 with the output of the timer/counter 731 suchthat the control circuit 710 can determine the position of the I-beam714 at a specific time (t) relative to a starting position or the time(t) when the I-beam 714 is at a specific position relative to a startingposition. The timer/counter 731 may be configured to measure elapsedtime, count external events, or time external events.

In one aspect, the control circuit 710 may be programmed to controlfunctions of the end effector 702 based on one or more tissueconditions. The control circuit 710 may be programmed to sense tissueconditions, such as thickness, either directly or indirectly, asdescribed herein. The control circuit 710 may be programmed to select afiring control program or closure control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 710 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 710 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power. A closure control program may control theclosure force applied to the tissue by the anvil 716. Other controlprograms control the rotation of the shaft 740 and the articulationmembers 742 a, 742 b.

In one aspect, the control circuit 710 may generate motor set pointsignals. The motor set point signals may be provided to various motorcontrollers 708 a-708 e. The motor controllers 708 a-708 e may compriseone or more circuits configured to provide motor drive signals to themotors 704 a-704 e to drive the motors 704 a-704 e as described herein.In some examples, the motors 704 a-704 e may be brushed DC electricmotors. For example, the velocity of the motors 704 a-704 e may beproportional to the respective motor drive signals. In some examples,the motors 704 a-704 e may be brushless DC electric motors, and therespective motor drive signals may comprise a PWM signal provided to oneor more stator windings of the motors 704 a-704 e. Also, in someexamples, the motor controllers 708 a-708 e may be omitted and thecontrol circuit 710 may generate the motor drive signals directly.

In one aspect, the control circuit 710 may initially operate each of themotors 704 a-704 e in an open-loop configuration for a first open-loopportion of a stroke of the displacement member. Based on the response ofthe robotic surgical instrument 700 during the open-loop portion of thestroke, the control circuit 710 may select a firing control program in aclosed-loop configuration. The response of the instrument may include atranslation distance of the displacement member during the open-loopportion, a time elapsed during the open-loop portion, the energyprovided to one of the motors 704 a-704 e during the open-loop portion,a sum of pulse widths of a motor drive signal, etc. After the open-loopportion, the control circuit 710 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during a closed-loop portion of the stroke, the controlcircuit 710 may modulate one of the motors 704 a-704 e based ontranslation data describing a position of the displacement member in aclosed-loop manner to translate the displacement member at a constantvelocity.

In one aspect, the motors 704 a-704 e may receive power from an energysource 712. The energy source 712 may be a DC power supply driven by amain alternating current power source, a battery, a super capacitor, orany other suitable energy source. The motors 704 a-704 e may bemechanically coupled to individual movable mechanical elements such asthe I-beam 714, anvil 716, shaft 740, articulation 742 a, andarticulation 742 b via respective transmissions 706 a-706 e. Thetransmissions 706 a-706 e may include one or more gears or other linkagecomponents to couple the motors 704 a-704 e to movable mechanicalelements. A position sensor 734 may sense a position of the I-beam 714.The position sensor 734 may be or include any type of sensor that iscapable of generating position data that indicate a position of theI-beam 714. In some examples, the position sensor 734 may include anencoder configured to provide a series of pulses to the control circuit710 as the I-beam 714 translates distally and proximally. The controlcircuit 710 may track the pulses to determine the position of the I-beam714. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 714. Also, in someexamples, the position sensor 734 may be omitted. Where any of themotors 704 a-704 e is a stepper motor, the control circuit 710 may trackthe position of the I-beam 714 by aggregating the number and directionof steps that the motor 704 has been instructed to execute. The positionsensor 734 may be located in the end effector 702 or at any otherportion of the instrument. The outputs of each of the motors 704 a-704 einclude a torque sensor 744 a-744 e to sense force and have an encoderto sense rotation of the drive shaft.

In one aspect, the control circuit 710 is configured to drive a firingmember such as the I-beam 714 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 a,which provides a drive signal to the motor 704 a. The output shaft ofthe motor 704 a is coupled to a torque sensor 744 a. The torque sensor744 a is coupled to a transmission 706 a which is coupled to the I-beam714. The transmission 706 a comprises movable mechanical elements suchas rotating elements and a firing member to control the movement of theI-beam 714 distally and proximally along a longitudinal axis of the endeffector 702. In one aspect, the motor 704 a may be coupled to the knifegear assembly, which includes a knife gear reduction set that includes afirst knife drive gear and a second knife drive gear. A torque sensor744 a provides a firing force feedback signal to the control circuit710. The firing force signal represents the force required to fire ordisplace the I-beam 714. A position sensor 734 may be configured toprovide the position of the I-beam 714 along the firing stroke or theposition of the firing member as a feedback signal to the controlcircuit 710. The end effector 702 may include additional sensors 738configured to provide feedback signals to the control circuit 710. Whenready to use, the control circuit 710 may provide a firing signal to themotor control 708 a. In response to the firing signal, the motor 704 amay drive the firing member distally along the longitudinal axis of theend effector 702 from a proximal stroke start position to a stroke endposition distal to the stroke start position. As the firing membertranslates distally, an I-beam 714, with a cutting element positioned ata distal end, advances distally to cut tissue located between the staplecartridge 718 and the anvil 716.

In one aspect, the control circuit 710 is configured to drive a closuremember such as the anvil 716 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 b,which provides a drive signal to the motor 704 b. The output shaft ofthe motor 704 b is coupled to a torque sensor 744 b. The torque sensor744 b is coupled to a transmission 706 b which is coupled to the anvil716. The transmission 706 b comprises movable mechanical elements suchas rotating elements and a closure member to control the movement of theanvil 716 from the open and closed positions. In one aspect, the motor704 b is coupled to a closure gear assembly, which includes a closurereduction gear set that is supported in meshing engagement with theclosure spur gear. The torque sensor 744 b provides a closure forcefeedback signal to the control circuit 710. The closure force feedbacksignal represents the closure force applied to the anvil 716. Theposition sensor 734 may be configured to provide the position of theclosure member as a feedback signal to the control circuit 710.Additional sensors 738 in the end effector 702 may provide the closureforce feedback signal to the control circuit 710. The pivotable anvil716 is positioned opposite the staple cartridge 718. When ready to use,the control circuit 710 may provide a closure signal to the motorcontrol 708 b. In response to the closure signal, the motor 704 badvances a closure member to grasp tissue between the anvil 716 and thestaple cartridge 718.

In one aspect, the control circuit 710 is configured to rotate a shaftmember such as the shaft 740 to rotate the end effector 702. The controlcircuit 710 provides a motor set point to a motor control 708 c, whichprovides a drive signal to the motor 704 c. The output shaft of themotor 704 c is coupled to a torque sensor 744 c. The torque sensor 744 cis coupled to a transmission 706 c which is coupled to the shaft 740.The transmission 706 c comprises movable mechanical elements such asrotating elements to control the rotation of the shaft 740 clockwise orcounterclockwise up to and over 360°. In one aspect, the motor 704 c iscoupled to the rotational transmission assembly, which includes a tubegear segment that is formed on (or attached to) the proximal end of theproximal closure tube for operable engagement by a rotational gearassembly that is operably supported on the tool mounting plate. Thetorque sensor 744 c provides a rotation force feedback signal to thecontrol circuit 710. The rotation force feedback signal represents therotation force applied to the shaft 740. The position sensor 734 may beconfigured to provide the position of the closure member as a feedbacksignal to the control circuit 710. Additional sensors 738 such as ashaft encoder may provide the rotational position of the shaft 740 tothe control circuit 710.

In one aspect, the control circuit 710 is configured to articulate theend effector 702. The control circuit 710 provides a motor set point toa motor control 708 d, which provides a drive signal to the motor 704 d.The output shaft of the motor 704 d is coupled to a torque sensor 744 d.The torque sensor 744 d is coupled to a transmission 706 d which iscoupled to an articulation member 742 a. The transmission 706 dcomprises movable mechanical elements such as articulation elements tocontrol the articulation of the end effector 702 ±65°. In one aspect,the motor 704 d is coupled to an articulation nut, which is rotatablyjournaled on the proximal end portion of the distal spine portion and isrotatably driven thereon by an articulation gear assembly. The torquesensor 744 d provides an articulation force feedback signal to thecontrol circuit 710. The articulation force feedback signal representsthe articulation force applied to the end effector 702. Sensors 738,such as an articulation encoder, may provide the articulation positionof the end effector 702 to the control circuit 710.

In another aspect, the articulation function of the robotic surgicalsystem 700 may comprise two articulation members, or links, 742 a, 742b. These articulation members 742 a, 742 b are driven by separate diskson the robot interface (the rack) which are driven by the two motors 708d, 708 e. When the separate firing motor 704 a is provided, each ofarticulation links 742 a, 742 b can be antagonistically driven withrespect to the other link in order to provide a resistive holding motionand a load to the head when it is not moving and to provide anarticulation motion as the head is articulated. The articulation members742 a, 742 b attach to the head at a fixed radius as the head isrotated. Accordingly, the mechanical advantage of the push-and-pull linkchanges as the head is rotated. This change in the mechanical advantagemay be more pronounced with other articulation link drive systems.

In one aspect, the one or more motors 704 a-704 e may comprise a brushedDC motor with a gearbox and mechanical links to a firing member, closuremember, or articulation member. Another example includes electric motors704 a-704 e that operate the movable mechanical elements such as thedisplacement member, articulation links, closure tube, and shaft. Anoutside influence is an unmeasured, unpredictable influence of thingslike tissue, surrounding bodies, and friction on the physical system.Such outside influence can be referred to as drag, which acts inopposition to one of electric motors 704 a-704 e. The outside influence,such as drag, may cause the operation of the physical system to deviatefrom a desired operation of the physical system.

In one aspect, the position sensor 734 may be implemented as an absolutepositioning system. In one aspect, the position sensor 734 may comprisea magnetic rotary absolute positioning system implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 734 may interface with thecontrol circuit 710 to provide an absolute positioning system. Theposition may include multiple Hall-effect elements located above amagnet and coupled to a CORDIC processor, also known as thedigit-by-digit method and Volder's algorithm, that is provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bitshift, and table lookup operations.

In one aspect, the control circuit 710 may be in communication with oneor more sensors 738. The sensors 738 may be positioned on the endeffector 702 and adapted to operate with the robotic surgical instrument700 to measure the various derived parameters such as the gap distanceversus time, tissue compression versus time, and anvil strain versustime. The sensors 738 may comprise a magnetic sensor, a magnetic fieldsensor, a strain gauge, a load cell, a pressure sensor, a force sensor,a torque sensor, an inductive sensor such as an eddy current sensor, aresistive sensor, a capacitive sensor, an optical sensor, and/or anyother suitable sensor for measuring one or more parameters of the endeffector 702. The sensors 738 may include one or more sensors. Thesensors 738 may be located on the staple cartridge 718 deck to determinetissue location using segmented electrodes. The torque sensors 744 a-744e may be configured to sense force such as firing force, closure force,and/or articulation force, among others. Accordingly, the controlcircuit 710 can sense (1) the closure load experienced by the distalclosure tube and its position, (2) the firing member at the rack and itsposition, (3) what portion of the staple cartridge 718 has tissue on it,and (4) the load and position on both articulation rods.

In one aspect, the one or more sensors 738 may comprise a strain gauge,such as a micro-strain gauge, configured to measure the magnitude of thestrain in the anvil 716 during a clamped condition. The strain gaugeprovides an electrical signal whose amplitude varies with the magnitudeof the strain. The sensors 738 may comprise a pressure sensor configuredto detect a pressure generated by the presence of compressed tissuebetween the anvil 716 and the staple cartridge 718. The sensors 738 maybe configured to detect impedance of a tissue section located betweenthe anvil 716 and the staple cartridge 718 that is indicative of thethickness and/or fullness of tissue located therebetween.

In one aspect, the sensors 738 may be implemented as one or more limitswitches, electromechanical devices, solid-state switches, Hall-effectdevices, magneto-resistive (MR) devices, giant magneto-resistive (GMR)devices, magnetometers, among others. In other implementations, thesensors 738 may be implemented as solid-state switches that operateunder the influence of light, such as optical sensors, IR sensors,ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors738 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the sensors 738 may be configured to measure forcesexerted on the anvil 716 by the closure drive system. For example, oneor more sensors 738 can be at an interaction point between the closuretube and the anvil 716 to detect the closure forces applied by theclosure tube to the anvil 716. The forces exerted on the anvil 716 canbe representative of the tissue compression experienced by the tissuesection captured between the anvil 716 and the staple cartridge 718. Theone or more sensors 738 can be positioned at various interaction pointsalong the closure drive system to detect the closure forces applied tothe anvil 716 by the closure drive system. The one or more sensors 738may be sampled in real time during a clamping operation by the processorof the control circuit 710. The control circuit 710 receives real-timesample measurements to provide and analyze time-based information andassess, in real time, closure forces applied to the anvil 716.

In one aspect, a current sensor 736 can be employed to measure thecurrent drawn by each of the motors 704 a-704 e. The force required toadvance any of the movable mechanical elements such as the I-beam 714corresponds to the current drawn by one of the motors 704 a-704 e. Theforce is converted to a digital signal and provided to the controlcircuit 710. The control circuit 710 can be configured to simulate theresponse of the actual system of the instrument in the software of thecontroller. A displacement member can be actuated to move an I-beam 714in the end effector 702 at or near a target velocity. The roboticsurgical instrument 700 can include a feedback controller, which can beone of any feedback controllers, including, but not limited to a PID, astate feedback, a linear-quadratic (LQR), and/or an adaptive controller,for example. The robotic surgical instrument 700 can include a powersource to convert the signal from the feedback controller into aphysical input such as case voltage, PWM voltage, frequency modulatedvoltage, current, torque, and/or force, for example. Additional detailsare disclosed in U.S. patent application Ser. No. 15/636,829, titledCLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT,filed Jun. 29, 2017, which is herein incorporated by reference in itsentirety.

FIG. 18 illustrates a block diagram of a surgical instrument 750programmed to control the distal translation of a displacement memberaccording to one aspect of this disclosure. In one aspect, the surgicalinstrument 750 is programmed to control the distal translation of adisplacement member such as the I-beam 764. The surgical instrument 750comprises an end effector 752 that may comprise an anvil 766, an I-beam764 (including a sharp cutting edge), and a removable staple cartridge768.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensor784. Because the I-beam 764 is coupled to a longitudinally movable drivemember, the position of the I-beam 764 can be determined by measuringthe position of the longitudinally movable drive member employing theposition sensor 784. Accordingly, in the following description, theposition, displacement, and/or translation of the I-beam 764 can beachieved by the position sensor 784 as described herein. A controlcircuit 760 may be programmed to control the translation of thedisplacement member, such as the I-beam 764. The control circuit 760, insome examples, may comprise one or more microcontrollers,microprocessors, or other suitable processors for executing instructionsthat cause the processor or processors to control the displacementmember, e.g., the I-beam 764, in the manner described. In one aspect, atimer/counter 781 provides an output signal, such as the elapsed time ora digital count, to the control circuit 760 to correlate the position ofthe I-beam 764 as determined by the position sensor 784 with the outputof the timer/counter 781 such that the control circuit 760 can determinethe position of the I-beam 764 at a specific time (t) relative to astarting position. The timer/counter 781 may be configured to measureelapsed time, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor 754 has been instructed to execute. The position sensor 784 may belocated in the end effector 752 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 752 andadapted to operate with the surgical instrument 750 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 752. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by a closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor of the control circuit760. The control circuit 760 receives real-time sample measurements toprovide and analyze time-based information and assess, in real time,closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

The control circuit 760 can be configured to simulate the response ofthe actual system of the instrument in the software of the controller. Adisplacement member can be actuated to move an I-beam 764 in the endeffector 752 at or near a target velocity. The surgical instrument 750can include a feedback controller, which can be one of any feedbackcontrollers, including, but not limited to a PID, a state feedback, LQR,and/or an adaptive controller, for example. The surgical instrument 750can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.

The actual drive system of the surgical instrument 750 is configured todrive the displacement member, cutting member, or I-beam 764, by abrushed DC motor with gearbox and mechanical links to an articulationand/or knife system. Another example is the electric motor 754 thatoperates the displacement member and the articulation driver, forexample, of an interchangeable shaft assembly. An outside influence isan unmeasured, unpredictable influence of things like tissue,surrounding bodies and friction on the physical system. Such outsideinfluence can be referred to as drag which acts in opposition to theelectric motor 754. The outside influence, such as drag, may cause theoperation of the physical system to deviate from a desired operation ofthe physical system.

Various example aspects are directed to a surgical instrument 750comprising an end effector 752 with motor-driven surgical stapling andcutting implements. For example, a motor 754 may drive a displacementmember distally and proximally along a longitudinal axis of the endeffector 752. The end effector 752 may comprise a pivotable anvil 766and, when configured for use, a staple cartridge 768 positioned oppositethe anvil 766. A clinician may grasp tissue between the anvil 766 andthe staple cartridge 768, as described herein. When ready to use theinstrument 750, the clinician may provide a firing signal, for exampleby depressing a trigger of the instrument 750. In response to the firingsignal, the motor 754 may drive the displacement member distally alongthe longitudinal axis of the end effector 752 from a proximal strokebegin position to a stroke end position distal of the stroke beginposition. As the displacement member translates distally, an I-beam 764with a cutting element positioned at a distal end, may cut the tissuebetween the staple cartridge 768 and the anvil 766.

In various examples, the surgical instrument 750 may comprise a controlcircuit 760 programmed to control the distal translation of thedisplacement member, such as the I-beam 764, for example, based on oneor more tissue conditions. The control circuit 760 may be programmed tosense tissue conditions, such as thickness, either directly orindirectly, as described herein. The control circuit 760 may beprogrammed to select a firing control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 760 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 760 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power.

In some examples, the control circuit 760 may initially operate themotor 754 in an open loop configuration for a first open loop portion ofa stroke of the displacement member. Based on a response of theinstrument 750 during the open loop portion of the stroke, the controlcircuit 760 may select a firing control program. The response of theinstrument may include, a translation distance of the displacementmember during the open loop portion, a time elapsed during the open loopportion, energy provided to the motor 754 during the open loop portion,a sum of pulse widths of a motor drive signal, etc. After the open loopportion, the control circuit 760 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during the closed loop portion of the stroke, the controlcircuit 760 may modulate the motor 754 based on translation datadescribing a position of the displacement member in a closed loop mannerto translate the displacement member at a constant velocity. Additionaldetails are disclosed in U.S. patent application Ser. No. 15/720,852,titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICALINSTRUMENT, filed Sep. 29, 2017, which is herein incorporated byreference in its entirety.

FIG. 19 is a schematic diagram of a surgical instrument 790 configuredto control various functions according to one aspect of this disclosure.In one aspect, the surgical instrument 790 is programmed to controldistal translation of a displacement member such as the I-beam 764. Thesurgical instrument 790 comprises an end effector 792 that may comprisean anvil 766, an I-beam 764, and a removable staple cartridge 768 whichmay be interchanged with an RF cartridge 796 (shown in dashed line).

In one aspect, sensors 788 may be implemented as a limit switch,electromechanical device, solid-state switches, Hall-effect devices, MRdevices, GMR devices, magnetometers, among others. In otherimplementations, the sensors 638 may be solid-state switches thatoperate under the influence of light, such as optical sensors, IRsensors, ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors788 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolutepositioning system comprising a magnetic rotary absolute positioningsystem implemented as an AS5055EQFT single-chip magnetic rotary positionsensor available from Austria Microsystems, AG. The position sensor 784may interface with the control circuit 760 to provide an absolutepositioning system. The position may include multiple Hall-effectelements located above a magnet and coupled to a CORDIC processor, alsoknown as the digit-by-digit method and Volder's algorithm, that isprovided to implement a simple and efficient algorithm to calculatehyperbolic and trigonometric functions that require only addition,subtraction, bitshift, and table lookup operations.

In one aspect, the I-beam 764 may be implemented as a knife membercomprising a knife body that operably supports a tissue cutting bladethereon and may further include anvil engagement tabs or features andchannel engagement features or a foot. In one aspect, the staplecartridge 768 may be implemented as a standard (mechanical) surgicalfastener cartridge. In one aspect, the RF cartridge 796 may beimplemented as an RF cartridge. These and other sensors arrangements aredescribed in commonly owned U.S. patent application Ser. No. 15/628,175,titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICALSTAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is hereinincorporated by reference in its entirety.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensorrepresented as position sensor 784. Because the I-beam 764 is coupled tothe longitudinally movable drive member, the position of the I-beam 764can be determined by measuring the position of the longitudinallymovable drive member employing the position sensor 784. Accordingly, inthe following description, the position, displacement, and/ortranslation of the I-beam 764 can be achieved by the position sensor 784as described herein. A control circuit 760 may be programmed to controlthe translation of the displacement member, such as the I-beam 764, asdescribed herein. The control circuit 760, in some examples, maycomprise one or more microcontrollers, microprocessors, or othersuitable processors for executing instructions that cause the processoror processors to control the displacement member, e.g., the I-beam 764,in the manner described. In one aspect, a timer/counter 781 provides anoutput signal, such as the elapsed time or a digital count, to thecontrol circuit 760 to correlate the position of the I-beam 764 asdetermined by the position sensor 784 with the output of thetimer/counter 781 such that the control circuit 760 can determine theposition of the I-beam 764 at a specific time (t) relative to a startingposition. The timer/counter 781 may be configured to measure elapsedtime, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor has been instructed to execute. The position sensor 784 may belocated in the end effector 792 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 792 andadapted to operate with the surgical instrument 790 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 792. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by the closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor portion of the controlcircuit 760. The control circuit 760 receives real-time samplemeasurements to provide and analyze time-based information and assess,in real time, closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

An RF energy source 794 is coupled to the end effector 792 and isapplied to the RF cartridge 796 when the RF cartridge 796 is loaded inthe end effector 792 in place of the staple cartridge 768. The controlcircuit 760 controls the delivery of the RF energy to the RF cartridge796.

Additional details are disclosed in U.S. patent application Ser. No.15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE ANDRADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28,2017, which is herein incorporated by reference in its entirety.

Generator Hardware

FIG. 20 is a simplified block diagram of a generator 800 configured toprovide inductorless tuning, among other benefits. Additional details ofthe generator 800 are described in U.S. Pat. No. 9,060,775, titledSURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, whichissued on Jun. 23, 2015, which is herein incorporated by reference inits entirety. The generator 800 may comprise a patient isolated stage802 in communication with a non-isolated stage 804 via a powertransformer 806. A secondary winding 808 of the power transformer 806 iscontained in the isolated stage 802 and may comprise a tappedconfiguration (e.g., a center-tapped or a non-center-tappedconfiguration) to define drive signal outputs 810 a, 810 b, 810 c fordelivering drive signals to different surgical instruments, such as, forexample, an ultrasonic surgical instrument, an RF electrosurgicalinstrument, and a multifunction surgical instrument which includesultrasonic and RF energy modes that can be delivered alone orsimultaneously. In particular, drive signal outputs 810 a, 810 c mayoutput an ultrasonic drive signal (e.g., a 420V root-mean-square (RMS)drive signal) to an ultrasonic surgical instrument, and drive signaloutputs 810 b, 810 c may output an RF electrosurgical drive signal(e.g., a 100V RMS drive signal) to an RF electrosurgical instrument,with the drive signal output 810 b corresponding to the center tap ofthe power transformer 806.

In certain forms, the ultrasonic and electrosurgical drive signals maybe provided simultaneously to distinct surgical instruments and/or to asingle surgical instrument, such as the multifunction surgicalinstrument, having the capability to deliver both ultrasonic andelectrosurgical energy to tissue. It will be appreciated that theelectrosurgical signal, provided either to a dedicated electrosurgicalinstrument and/or to a combined multifunction ultrasonic/electrosurgicalinstrument may be either a therapeutic or sub-therapeutic level signalwhere the sub-therapeutic signal can be used, for example, to monitortissue or instrument conditions and provide feedback to the generator.For example, the ultrasonic and RF signals can be delivered separatelyor simultaneously from a generator with a single output port in order toprovide the desired output signal to the surgical instrument, as will bediscussed in more detail below. Accordingly, the generator can combinethe ultrasonic and electrosurgical RF energies and deliver the combinedenergies to the multifunction ultrasonic/electrosurgical instrument.Bipolar electrodes can be placed on one or both jaws of the endeffector. One jaw may be driven by ultrasonic energy in addition toelectrosurgical RF energy, working simultaneously. The ultrasonic energymay be employed to dissect tissue, while the electrosurgical RF energymay be employed for vessel sealing.

The non-isolated stage 804 may comprise a power amplifier 812 having anoutput connected to a primary winding 814 of the power transformer 806.In certain forms, the power amplifier 812 may comprise a push-pullamplifier. For example, the non-isolated stage 804 may further comprisea logic device 816 for supplying a digital output to a digital-to-analogconverter (DAC) circuit 818, which in turn supplies a correspondinganalog signal to an input of the power amplifier 812. In certain forms,the logic device 816 may comprise a programmable gate array (PGA), aFPGA, programmable logic device (PLD), among other logic circuits, forexample. The logic device 816, by virtue of controlling the input of thepower amplifier 812 via the DAC circuit 818, may therefore control anyof a number of parameters (e.g., frequency, waveform shape, waveformamplitude) of drive signals appearing at the drive signal outputs 810 a,810 b, 810 c. In certain forms and as discussed below, the logic device816, in conjunction with a processor (e.g., a DSP discussed below), mayimplement a number of DSP-based and/or other control algorithms tocontrol parameters of the drive signals output by the generator 800.

Power may be supplied to a power rail of the power amplifier 812 by aswitch-mode regulator 820, e.g., a power converter. In certain forms,the switch-mode regulator 820 may comprise an adjustable buck regulator,for example. The non-isolated stage 804 may further comprise a firstprocessor 822, which in one form may comprise a DSP processor such as anAnalog Devices ADSP-21469 SHARC DSP, available from Analog Devices,Norwood, Mass., for example, although in various forms any suitableprocessor may be employed. In certain forms the DSP processor 822 maycontrol the operation of the switch-mode regulator 820 responsive tovoltage feedback data received from the power amplifier 812 by the DSPprocessor 822 via an ADC circuit 824. In one form, for example, the DSPprocessor 822 may receive as input, via the ADC circuit 824, thewaveform envelope of a signal (e.g., an RF signal) being amplified bythe power amplifier 812. The DSP processor 822 may then control theswitch-mode regulator 820 (e.g., via a PWM output) such that the railvoltage supplied to the power amplifier 812 tracks the waveform envelopeof the amplified signal. By dynamically modulating the rail voltage ofthe power amplifier 812 based on the waveform envelope, the efficiencyof the power amplifier 812 may be significantly improved relative to afixed rail voltage amplifier schemes.

In certain forms, the logic device 816, in conjunction with the DSPprocessor 822, may implement a digital synthesis circuit such as adirect digital synthesizer control scheme to control the waveform shape,frequency, and/or amplitude of drive signals output by the generator800. In one form, for example, the logic device 816 may implement a DDScontrol algorithm by recalling waveform samples stored in a dynamicallyupdated lookup table (LUT), such as a RAM LUT, which may be embedded inan FPGA. This control algorithm is particularly useful for ultrasonicapplications in which an ultrasonic transducer, such as an ultrasonictransducer, may be driven by a clean sinusoidal current at its resonantfrequency. Because other frequencies may excite parasitic resonances,minimizing or reducing the total distortion of the motional branchcurrent may correspondingly minimize or reduce undesirable resonanceeffects. Because the waveform shape of a drive signal output by thegenerator 800 is impacted by various sources of distortion present inthe output drive circuit (e.g., the power transformer 806, the poweramplifier 812), voltage and current feedback data based on the drivesignal may be input into an algorithm, such as an error controlalgorithm implemented by the DSP processor 822, which compensates fordistortion by suitably pre-distorting or modifying the waveform samplesstored in the LUT on a dynamic, ongoing basis (e.g., in real time). Inone form, the amount or degree of pre-distortion applied to the LUTsamples may be based on the error between a computed motional branchcurrent and a desired current waveform shape, with the error beingdetermined on a sample-by-sample basis. In this way, the pre-distortedLUT samples, when processed through the drive circuit, may result in amotional branch drive signal having the desired waveform shape (e.g.,sinusoidal) for optimally driving the ultrasonic transducer. In suchforms, the LUT waveform samples will therefore not represent the desiredwaveform shape of the drive signal, but rather the waveform shape thatis required to ultimately produce the desired waveform shape of themotional branch drive signal when distortion effects are taken intoaccount.

The non-isolated stage 804 may further comprise a first ADC circuit 826and a second ADC circuit 828 coupled to the output of the powertransformer 806 via respective isolation transformers 830, 832 forrespectively sampling the voltage and current of drive signals output bythe generator 800. In certain forms, the ADC circuits 826, 828 may beconfigured to sample at high speeds (e.g., 80 mega samples per second(MSPS)) to enable oversampling of the drive signals. In one form, forexample, the sampling speed of the ADC circuits 826, 828 may enableapproximately 200× (depending on frequency) oversampling of the drivesignals. In certain forms, the sampling operations of the ADC circuit826, 828 may be performed by a single ADC circuit receiving inputvoltage and current signals via a two-way multiplexer. The use ofhigh-speed sampling in forms of the generator 800 may enable, amongother things, calculation of the complex current flowing through themotional branch (which may be used in certain forms to implementDDS-based waveform shape control described above), accurate digitalfiltering of the sampled signals, and calculation of real powerconsumption with a high degree of precision. Voltage and currentfeedback data output by the ADC circuits 826, 828 may be received andprocessed (e.g., first-in-first-out (FIFO) buffer, multiplexer) by thelogic device 816 and stored in data memory for subsequent retrieval by,for example, the DSP processor 822. As noted above, voltage and currentfeedback data may be used as input to an algorithm for pre-distorting ormodifying LUT waveform samples on a dynamic and ongoing basis. Incertain forms, this may require each stored voltage and current feedbackdata pair to be indexed based on, or otherwise associated with, acorresponding LUT sample that was output by the logic device 816 whenthe voltage and current feedback data pair was acquired. Synchronizationof the LUT samples and the voltage and current feedback data in thismanner contributes to the correct timing and stability of thepre-distortion algorithm.

In certain forms, the voltage and current feedback data may be used tocontrol the frequency and/or amplitude (e.g., current amplitude) of thedrive signals. In one form, for example, voltage and current feedbackdata may be used to determine impedance phase. The frequency of thedrive signal may then be controlled to minimize or reduce the differencebetween the determined impedance phase and an impedance phase setpoint(e.g., 0°), thereby minimizing or reducing the effects of harmonicdistortion and correspondingly enhancing impedance phase measurementaccuracy. The determination of phase impedance and a frequency controlsignal may be implemented in the DSP processor 822, for example, withthe frequency control signal being supplied as input to a DDS controlalgorithm implemented by the logic device 816.

In another form, for example, the current feedback data may be monitoredin order to maintain the current amplitude of the drive signal at acurrent amplitude setpoint. The current amplitude setpoint may bespecified directly or determined indirectly based on specified voltageamplitude and power setpoints. In certain forms, control of the currentamplitude may be implemented by control algorithm, such as, for example,a proportional-integral-derivative (PID) control algorithm, in the DSPprocessor 822. Variables controlled by the control algorithm to suitablycontrol the current amplitude of the drive signal may include, forexample, the scaling of the LUT waveform samples stored in the logicdevice 816 and/or the full-scale output voltage of the DAC circuit 818(which supplies the input to the power amplifier 812) via a DAC circuit834.

The non-isolated stage 804 may further comprise a second processor 836for providing, among other things user interface (UI) functionality. Inone form, the UI processor 836 may comprise an Atmel AT91SAM9263processor having an ARM 926EJ-S core, available from Atmel Corporation,San Jose, Calif., for example. Examples of UI functionality supported bythe UI processor 836 may include audible and visual user feedback,communication with peripheral devices (e.g., via a USB interface),communication with a foot switch, communication with an input device(e.g., a touch screen display) and communication with an output device(e.g., a speaker). The UI processor 836 may communicate with the DSPprocessor 822 and the logic device 816 (e.g., via SPI buses). Althoughthe UI processor 836 may primarily support UI functionality, it may alsocoordinate with the DSP processor 822 to implement hazard mitigation incertain forms. For example, the UI processor 836 may be programmed tomonitor various aspects of user input and/or other inputs (e.g., touchscreen inputs, foot switch inputs, temperature sensor inputs) and maydisable the drive output of the generator 800 when an erroneouscondition is detected.

In certain forms, both the DSP processor 822 and the UI processor 836,for example, may determine and monitor the operating state of thegenerator 800. For the DSP processor 822, the operating state of thegenerator 800 may dictate, for example, which control and/or diagnosticprocesses are implemented by the DSP processor 822. For the UI processor836, the operating state of the generator 800 may dictate, for example,which elements of a UI (e.g., display screens, sounds) are presented toa user. The respective DSP and UI processors 822, 836 may independentlymaintain the current operating state of the generator 800 and recognizeand evaluate possible transitions out of the current operating state.The DSP processor 822 may function as the master in this relationshipand determine when transitions between operating states are to occur.The UI processor 836 may be aware of valid transitions between operatingstates and may confirm if a particular transition is appropriate. Forexample, when the DSP processor 822 instructs the UI processor 836 totransition to a specific state, the UI processor 836 may verify thatrequested transition is valid. In the event that a requested transitionbetween states is determined to be invalid by the UI processor 836, theUI processor 836 may cause the generator 800 to enter a failure mode.

The non-isolated stage 804 may further comprise a controller 838 formonitoring input devices (e.g., a capacitive touch sensor used forturning the generator 800 on and off, a capacitive touch screen). Incertain forms, the controller 838 may comprise at least one processorand/or other controller device in communication with the UI processor836. In one form, for example, the controller 838 may comprise aprocessor (e.g., a Meg168 8-bit controller available from Atmel)configured to monitor user input provided via one or more capacitivetouch sensors. In one form, the controller 838 may comprise a touchscreen controller (e.g., a QT5480 touch screen controller available fromAtmel) to control and manage the acquisition of touch data from acapacitive touch screen.

In certain forms, when the generator 800 is in a “power off” state, thecontroller 838 may continue to receive operating power (e.g., via a linefrom a power supply of the generator 800, such as the power supply 854discussed below). In this way, the controller 838 may continue tomonitor an input device (e.g., a capacitive touch sensor located on afront panel of the generator 800) for turning the generator 800 on andoff. When the generator 800 is in the power off state, the controller838 may wake the power supply (e.g., enable operation of one or moreDC/DC voltage converters 856 of the power supply 854) if activation ofthe “on/off” input device by a user is detected. The controller 838 maytherefore initiate a sequence for transitioning the generator 800 to a“power on” state. Conversely, the controller 838 may initiate a sequencefor transitioning the generator 800 to the power off state if activationof the “on/off” input device is detected when the generator 800 is inthe power on state. In certain forms, for example, the controller 838may report activation of the “on/off” input device to the UI processor836, which in turn implements the necessary process sequence fortransitioning the generator 800 to the power off state. In such forms,the controller 838 may have no independent ability for causing theremoval of power from the generator 800 after its power on state hasbeen established.

In certain forms, the controller 838 may cause the generator 800 toprovide audible or other sensory feedback for alerting the user that apower on or power off sequence has been initiated. Such an alert may beprovided at the beginning of a power on or power off sequence and priorto the commencement of other processes associated with the sequence.

In certain forms, the isolated stage 802 may comprise an instrumentinterface circuit 840 to, for example, provide a communication interfacebetween a control circuit of a surgical instrument (e.g., a controlcircuit comprising handpiece switches) and components of thenon-isolated stage 804, such as, for example, the logic device 816, theDSP processor 822, and/or the UI processor 836. The instrument interfacecircuit 840 may exchange information with components of the non-isolatedstage 804 via a communication link that maintains a suitable degree ofelectrical isolation between the isolated and non-isolated stages 802,804, such as, for example, an IR-based communication link. Power may besupplied to the instrument interface circuit 840 using, for example, alow-dropout voltage regulator powered by an isolation transformer drivenfrom the non-isolated stage 804.

In one form, the instrument interface circuit 840 may comprise a logiccircuit 842 (e.g., logic circuit, programmable logic circuit, PGA, FPGA,PLD) in communication with a signal conditioning circuit 844. The signalconditioning circuit 844 may be configured to receive a periodic signalfrom the logic circuit 842 (e.g., a 2 kHz square wave) to generate abipolar interrogation signal having an identical frequency. Theinterrogation signal may be generated, for example, using a bipolarcurrent source fed by a differential amplifier. The interrogation signalmay be communicated to a surgical instrument control circuit (e.g., byusing a conductive pair in a cable that connects the generator 800 tothe surgical instrument) and monitored to determine a state orconfiguration of the control circuit. The control circuit may comprise anumber of switches, resistors, and/or diodes to modify one or morecharacteristics (e.g., amplitude, rectification) of the interrogationsignal such that a state or configuration of the control circuit isuniquely discernable based on the one or more characteristics. In oneform, for example, the signal conditioning circuit 844 may comprise anADC circuit for generating samples of a voltage signal appearing acrossinputs of the control circuit resulting from passage of interrogationsignal therethrough. The logic circuit 842 (or a component of thenon-isolated stage 804) may then determine the state or configuration ofthe control circuit based on the ADC circuit samples.

In one form, the instrument interface circuit 840 may comprise a firstdata circuit interface 846 to enable information exchange between thelogic circuit 842 (or other element of the instrument interface circuit840) and a first data circuit disposed in or otherwise associated with asurgical instrument. In certain forms, for example, a first data circuitmay be disposed in a cable integrally attached to a surgical instrumenthandpiece or in an adaptor for interfacing a specific surgicalinstrument type or model with the generator 800. The first data circuitmay be implemented in any suitable manner and may communicate with thegenerator according to any suitable protocol, including, for example, asdescribed herein with respect to the first data circuit. In certainforms, the first data circuit may comprise a non-volatile storagedevice, such as an EEPROM device. In certain forms, the first datacircuit interface 846 may be implemented separately from the logiccircuit 842 and comprise suitable circuitry (e.g., discrete logicdevices, a processor) to enable communication between the logic circuit842 and the first data circuit. In other forms, the first data circuitinterface 846 may be integral with the logic circuit 842.

In certain forms, the first data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information. This informationmay be read by the instrument interface circuit 840 (e.g., by the logiccircuit 842), transferred to a component of the non-isolated stage 804(e.g., to logic device 816, DSP processor 822, and/or UI processor 836)for presentation to a user via an output device and/or for controlling afunction or operation of the generator 800. Additionally, any type ofinformation may be communicated to the first data circuit for storagetherein via the first data circuit interface 846 (e.g., using the logiccircuit 842). Such information may comprise, for example, an updatednumber of operations in which the surgical instrument has been usedand/or dates and/or times of its usage.

As discussed previously, a surgical instrument may be detachable from ahandpiece (e.g., the multifunction surgical instrument may be detachablefrom the handpiece) to promote instrument interchangeability and/ordisposability. In such cases, conventional generators may be limited intheir ability to recognize particular instrument configurations beingused and to optimize control and diagnostic processes accordingly. Theaddition of readable data circuits to surgical instruments to addressthis issue is problematic from a compatibility standpoint, however. Forexample, designing a surgical instrument to remain backwardly compatiblewith generators that lack the requisite data reading functionality maybe impractical due to, for example, differing signal schemes, designcomplexity, and cost. Forms of instruments discussed herein addressthese concerns by using data circuits that may be implemented inexisting surgical instruments economically and with minimal designchanges to preserve compatibility of the surgical instruments withcurrent generator platforms.

Additionally, forms of the generator 800 may enable communication withinstrument-based data circuits. For example, the generator 800 may beconfigured to communicate with a second data circuit contained in aninstrument (e.g., the multifunction surgical instrument). In some forms,the second data circuit may be implemented in a many similar to that ofthe first data circuit described herein. The instrument interfacecircuit 840 may comprise a second data circuit interface 848 to enablethis communication. In one form, the second data circuit interface 848may comprise a tri-state digital interface, although other interfacesmay also be used. In certain forms, the second data circuit maygenerally be any circuit for transmitting and/or receiving data. In oneform, for example, the second data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information.

In some forms, the second data circuit may store information about theelectrical and/or ultrasonic properties of an associated ultrasonictransducer, end effector, or ultrasonic drive system. For example, thefirst data circuit may indicate a burn-in frequency slope, as describedherein. Additionally or alternatively, any type of information may becommunicated to second data circuit for storage therein via the seconddata circuit interface 848 (e.g., using the logic circuit 842). Suchinformation may comprise, for example, an updated number of operationsin which the instrument has been used and/or dates and/or times of itsusage. In certain forms, the second data circuit may transmit dataacquired by one or more sensors (e.g., an instrument-based temperaturesensor). In certain forms, the second data circuit may receive data fromthe generator 800 and provide an indication to a user (e.g., a lightemitting diode indication or other visible indication) based on thereceived data.

In certain forms, the second data circuit and the second data circuitinterface 848 may be configured such that communication between thelogic circuit 842 and the second data circuit can be effected withoutthe need to provide additional conductors for this purpose (e.g.,dedicated conductors of a cable connecting a handpiece to the generator800). In one form, for example, information may be communicated to andfrom the second data circuit using a one-wire bus communication schemeimplemented on existing cabling, such as one of the conductors usedtransmit interrogation signals from the signal conditioning circuit 844to a control circuit in a handpiece. In this way, design changes ormodifications to the surgical instrument that might otherwise benecessary are minimized or reduced. Moreover, because different types ofcommunications implemented over a common physical channel can befrequency-band separated, the presence of a second data circuit may be“invisible” to generators that do not have the requisite data readingfunctionality, thus enabling backward compatibility of the surgicalinstrument.

In certain forms, the isolated stage 802 may comprise at least oneblocking capacitor 850-1 connected to the drive signal output 810 b toprevent passage of DC current to a patient. A single blocking capacitormay be required to comply with medical regulations or standards, forexample. While failure in single-capacitor designs is relativelyuncommon, such failure may nonetheless have negative consequences. Inone form, a second blocking capacitor 850-2 may be provided in serieswith the blocking capacitor 850-1, with current leakage from a pointbetween the blocking capacitors 850-1, 850-2 being monitored by, forexample, an ADC circuit 852 for sampling a voltage induced by leakagecurrent. The samples may be received by the logic circuit 842, forexample. Based changes in the leakage current (as indicated by thevoltage samples), the generator 800 may determine when at least one ofthe blocking capacitors 850-1, 850-2 has failed, thus providing abenefit over single-capacitor designs having a single point of failure.

In certain forms, the non-isolated stage 804 may comprise a power supply854 for delivering DC power at a suitable voltage and current. The powersupply may comprise, for example, a 400 W power supply for delivering a48 VDC system voltage. The power supply 854 may further comprise one ormore DC/DC voltage converters 856 for receiving the output of the powersupply to generate DC outputs at the voltages and currents required bythe various components of the generator 800. As discussed above inconnection with the controller 838, one or more of the DC/DC voltageconverters 856 may receive an input from the controller 838 whenactivation of the “on/off” input device by a user is detected by thecontroller 838 to enable operation of, or wake, the DC/DC voltageconverters 856.

FIG. 21 illustrates an example of a generator 900, which is one form ofthe generator 800 (FIG. 20). The generator 900 is configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and ultrasonic signals for delivering energy to a surgicalinstrument either independently or simultaneously. The RF and ultrasonicsignals may be provided alone or in combination and may be providedsimultaneously. As noted above, at least one generator output candeliver multiple energy modalities (e.g., ultrasonic, bipolar ormonopolar RF, irreversible and/or reversible electroporation, and/ormicrowave energy, among others) through a single port, and these signalscan be delivered separately or simultaneously to the end effector totreat tissue.

The generator 900 comprises a processor 902 coupled to a waveformgenerator 904. The processor 902 and waveform generator 904 areconfigured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 1106 for signal conditioningand amplification. The conditioned and amplified output of the amplifier906 is coupled to a power transformer 908. The signals are coupledacross the power transformer 908 to the secondary side, which is in thepatient isolation side. A first signal of a first energy modality isprovided to the surgical instrument between the terminals labeledENERGY1 and RETURN. A second signal of a second energy modality iscoupled across a capacitor 910 and is provided to the surgicalinstrument between the terminals labeled ENERGY2 and RETURN. It will beappreciated that more than two energy modalities may be output and thusthe subscript “n” may be used to designate that up to n ENERGYnterminals may be provided, where n is a positive integer greater than 1.It also will be appreciated that up to “n” return paths RETURNn may beprovided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY1 and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY2 and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 918. The outputs of the isolationtransformers 916, 928, 922 in the on the primary side of the powertransformer 908 (non-patient isolated side) are provided to a one ormore ADC circuit 926. The digitized output of the ADC circuit 926 isprovided to the processor 902 for further processing and computation.The output voltages and output current feedback information can beemployed to adjust the output voltage and current provided to thesurgical instrument and to compute output impedance, among otherparameters. Input/output communications between the processor 902 andpatient isolated circuits is provided through an interface circuit 920.Sensors also may be in electrical communication with the processor 902by way of the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY1/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY2/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY1 may be ultrasonic energy and the second energy modality ENERGY2may be RF energy. Nevertheless, in addition to ultrasonic and bipolar ormonopolar RF energy modalities, other energy modalities includeirreversible and/or reversible electroporation and/or microwave energy,among others. Also, although the example illustrated in FIG. 21 shows asingle return path RETURN may be provided for two or more energymodalities, in other aspects, multiple return paths RETURNn may beprovided for each energy modality ENERGYn. Thus, as described herein,the ultrasonic transducer impedance may be measured by dividing theoutput of the first voltage sensing circuit 912 by the current sensingcircuit 914 and the tissue impedance may be measured by dividing theoutput of the second voltage sensing circuit 924 by the current sensingcircuit 914.

As shown in FIG. 21, the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. The connection of an ultrasonic transducer tothe generator 900 output would be preferably located between the outputlabeled ENERGY1 and RETURN as shown in FIG. 21. In one example, aconnection of RF bipolar electrodes to the generator 900 output would bepreferably located between the output labeled ENERGY2 and RETURN. In thecase of monopolar output, the preferred connections would be activeelectrode (e.g., pencil or other probe) to the ENERGY2 output and asuitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

As used throughout this description, the term “wireless” and itsderivatives may be used to describe circuits, devices, systems, methods,techniques, communications channels, etc., that may communicate datathrough the use of modulated electromagnetic radiation through anon-solid medium. The term does not imply that the associated devices donot contain any wires, although in some aspects they might not. Thecommunication module may implement any of a number of wireless or wiredcommunication standards or protocols, including but not limited to W-Fi(IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long termevolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA,TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as anyother wireless and wired protocols that are designated as 3G, 4G, 5G,and beyond. The computing module may include a plurality ofcommunication modules. For instance, a first communication module may bededicated to shorter range wireless communications such as Wi-Fi andBluetooth and a second communication module may be dedicated to longerrange wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE,Ev-DO, and others.

As used herein a processor or processing unit is an electronic circuitwhich performs operations on some external data source, usually memoryor some other data stream. The term is used herein to refer to thecentral processor (central processing unit) in a system or computersystems (especially systems on a chip (SoCs)) that combine a number ofspecialized “processors.”

As used herein, a system on a chip or system on chip (SoC or SOC) is anintegrated circuit (also known as an “IC” or “chip”) that integrates allcomponents of a computer or other electronic systems. It may containdigital, analog, mixed-signal, and often radio-frequency functions—allon a single substrate. A SoC integrates a microcontroller (ormicroprocessor) with advanced peripherals like graphics processing unit(GPU), Wi-Fi module, or coprocessor. A SoC may or may not containbuilt-in memory.

As used herein, a microcontroller or controller is a system thatintegrates a microprocessor with peripheral circuits and memory. Amicrocontroller (or MCU for microcontroller unit) may be implemented asa small computer on a single integrated circuit. It may be similar to aSoC; an SoC may include a microcontroller as one of its components. Amicrocontroller may contain one or more core processing units (CPUs)along with memory and programmable input/output peripherals. Programmemory in the form of Ferroelectric RAM, NOR flash or OTP ROM is alsooften included on chip, as well as a small amount of RAM.Microcontrollers may be employed for embedded applications, in contrastto the microprocessors used in personal computers or other generalpurpose applications consisting of various discrete chips.

As used herein, the term controller or microcontroller may be astand-alone IC or chip device that interfaces with a peripheral device.This may be a link between two parts of a computer or a controller on anexternal device that manages the operation of (and connection with) thatdevice.

Any of the processors or microcontrollers described herein, may beimplemented by any single core or multicore processor such as thoseknown under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising on-chipmemory of 256 KB single-cycle flash memory, or other non-volatilememory, up to 40 MHz, a prefetch buffer to improve performance above 40MHz, a 32 KB single-cycle serial random access memory (SRAM), internalread-only memory (ROM) loaded with StellarisWare® software, 2 KBelectrically erasable programmable read-only memory (EEPROM), one ormore pulse width modulation (PWM) modules, one or more quadratureencoder inputs (QEI) analog, one or more 12-bit Analog-to-DigitalConverters (ADC) with 12 analog input channels, details of which areavailable for the product datasheet.

In one aspect, the processor may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

Modular devices include the modules (as described in connection withFIGS. 3 and 9, for example) that are receivable within a surgical huband the surgical devices or instruments that can be connected to thevarious modules in order to connect or pair with the correspondingsurgical hub. The modular devices include, for example, intelligentsurgical instruments, medical imaging devices, suction/irrigationdevices, smoke evacuators, energy generators, ventilators, insufflators,and displays. The modular devices described herein can be controlled bycontrol algorithms. The control algorithms can be executed on themodular device itself, on the surgical hub to which the particularmodular device is paired, or on both the modular device and the surgicalhub (e.g., via a distributed computing architecture). In someexemplifications, the modular devices' control algorithms control thedevices based on data sensed by the modular device itself (i.e., bysensors in, on, or connected to the modular device). This data can berelated to the patient being operated on (e.g., tissue properties orinsufflation pressure) or the modular device itself (e.g., the rate atwhich a knife is being advanced, motor current, or energy levels). Forexample, a control algorithm for a surgical stapling and cuttinginstrument can control the rate at which the instrument's motor drivesits knife through tissue according to resistance encountered by theknife as it advances.

USER FEEDBACK METHODS

The present disclosure provides user feedback techniques. In one aspect,the present disclosure provides a display of images through a medicalimaging device (e.g., laparoscope, endoscope, thoracoscope, and thelike). A medical imaging device comprises an optical component and animage sensor. The optical component may comprise a lens and a lightsource, for example. The image sensor may be implemented as a chargecoupled device (CCD) or complementary oxide semiconductor (CMOS). Theimage sensor provides image data to electronic components in thesurgical hub. The data representing the images may be transmitted bywired or wireless communication to display instrument status, feedbackdata, imaging data, and highlight tissue irregularities and underliningstructures. In another aspect, the present disclosure provides wired orwireless communication techniques for communicating user feedback from adevice (e.g., instrument, robot, or tool) to the surgical hub. Inanother aspect, the present disclosure provides identification and usagerecording and enabling. Finally, in another aspect, the surgical hub mayhave a direct interface control between the device and the surgical hub.

Through Laparoscope Monitor Display of Data

In various aspects, the present disclosure provides through laparoscopemonitor display of data. The through laparoscope monitor display of datamay comprise displaying a current instrument alignment to adjacentprevious operations, cooperation between local instrument displays andpaired laparoscope display, and display of instrument specific dataneeded for efficient use of an end-effector portion of a surgicalinstrument. Each of these techniques is described hereinbelow.

Display of Current Instrument Alignment to Adjacent Previous Operations

In one aspect, the present disclosure provides alignment guidancedisplay elements that provide the user information about the location ofa previous firing or actuation and allow them to align the nextinstrument use to the proper position without the need for seeing theinstrument directly. In another aspect, the first device and seconddevice and are separate; the first device is within the sterile fieldand the second is used from outside the sterile field.

During a colorectal transection using a double-stapling technique it isdifficult to align the location of an anvil trocar of a circular staplerwith the center of an overlapping staple line. During the procedure, theanvil trocar of the circular stapler is inserted in the rectum below thestaple line and a laparoscope is inserted in the peritoneal cavity abovethe staple line. Because the staple line seals off the colon, there isno light of sight to align the anvil trocar using the laparoscope tooptically align the anvil trocar insertion location relative to thecenter of the staple line overlap.

One solution provides a non-contact sensor located on the anvil trocarof the circular stapler and a target located at the distal end of thelaparoscope. Another solution provides a non-contact sensor located atthe distal end of the laparoscope and a target located on the anviltrocar of the circular stapler.

A surgical hub computer processor receives signals from the non-contactsensor and displays a centering tool on a screen indicating thealignment of the anvil trocar of the circular stapler and the overlapportion at the center of staple line. The screen displays a first imageof the target staple line with a radius around the staple line overlapportion and a second image of the projected anvil trocar location. Theanvil trocar and the overlap portion at the center of staple line arealigned when the first and second images overlap.

In one aspect, the present disclosure provides a surgical hub foraligning a surgical instrument. The surgical hub comprises a processorand a memory coupled to the processor. The memory stores instructionsexecutable by the processor to receive image data from an image sensor,generate a first image based on the image data, display the first imageon a monitor coupled to the processor, receive a signal from anon-contact sensor, generate a second image based on the position of thesurgical device, and display the second image on the monitor. The firstimage data represents a center of a staple line seal. The first imagerepresents a target corresponding to the center of the staple line. Thesignal is indicative of a position of a surgical device relative to thecenter of the staple line. The second image represents the position ofthe surgical device along a projected path of the surgical device towardthe center of the staple line.

In one aspect, the center of the staple line is a double-staple overlapportion zone. In another aspect, the image sensor receives an image froma laparoscope. In another aspect, the surgical device is a circularstapler comprising an anvil trocar and the non-contact sensor isconfigured to detect the location of the anvil trocar relative to thecenter of the staple line seal. In another aspect, the non-contactsensor is an inductive sensor. In another aspect, the non-contact sensoris a capacitive sensor.

In various aspects, the present disclosure provides a control circuit toalign the surgical instrument as described above. In various aspects,the present disclosure provides a non-transitory computer readablemedium storing computer readable instructions which, when executed,causes a machine to align the surgical instrument as described above.

This technique provides better alignment of a surgical instrument suchas a circular stapler about the overlap portion of the staple line toproduce a better seal and cut after the circular stapler is fired.

In one aspect, the present disclosure provides a system for displayingthe current instrument alignment relative to prior adjacent operations.The instrument alignment information may be displayed on a monitor orany suitable electronic device suitable for the visual presentation ofdata whether located locally on the instrument or remotely from theinstrument through the modular communication hub. The system may displaythe current alignment of a circular staple cartridge to an overlappingstaple line, display the current alignment of a circular staplecartridge relative to a prior linear staple line, and/or show theexisting staple line of the linear transection and an alignment circleindicating an appropriately centered circular staple cartridge. Each ofthese techniques is described hereinbelow.

In one aspect, the present disclosure provides alignment guidancedisplay elements that provide the user information about the location ofa previous firing or actuation of a surgical instrument (e.g., surgicalstapler) and allows the user to align the next instrument use (e.g.,firing or actuation of the surgical stapler) to the proper positionwithout the need for seeing the instrument directly. In another aspect,the present disclosure provides a first device and a second device thatis separate from the first device. The first device is located within asterile field and the second is located outside the sterile field. Thetechniques described herein may be applied to surgical staplers,ultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments.

FIG. 22 illustrates a diagram 6000 of a surgical instrument 6002centered on a staple line 6003 using the benefit of centering tools andtechniques described in connection with FIGS. 23-33, according to oneaspect of the present disclosure. As used in the following descriptionof FIGS. 23-33 a staple line may include multiple rows of staggeredstaples and typically includes two or three rows of staggered staples,without limitation. The staple line may be a double staple line 6004formed using a double-stapling technique as described in connection withFIGS. 23-27 or may be a linear staple line 6052 formed using a lineartransection technique as described in connection with FIGS. 28-33. Thecentering tools and techniques described herein can be used to align theinstrument 6002 located in one part of the anatomy with either thestaple line 6003 or with another instrument located in another part ofthe anatomy without the benefit of a line of sight. The centering toolsand techniques include displaying the current alignment of theinstrument 6002 adjacent to previous operations. The centering tool isuseful, for example, during laparoscopic-assisted rectal surgery thatemploy a double-stapling technique, also referred to as an overlappingstapling technique. In the illustrated example, during alaparoscopic-assisted rectal surgical procedure, a circular stapler 6002is positioned in the rectum 6006 of a patient within the pelvic cavity6008 and a laparoscope is positioned in the peritoneal cavity.

During the laparoscopic-assisted rectal surgery, the colon is transectedand sealed by the staple line 6003 having a length “l.” Thedouble-stapling technique uses the circular stapler 6002 to create anend-to-end anastomosis and is currently used widely inlaparoscopic-assisted rectal surgery. For a successful formation of ananastomosis using a circular stapler 6002, the anvil trocar 6010 of thecircular stapler 6002 should be aligned with the center “l/2” of thestaple line 6003 transection before puncturing through the center “l/2”of the staple line 6003 and/or fully clamping on the tissue beforefiring the circular stapler 6002 to cut out the staple overlap portion6012 and forming the anastomosis. Misalignment of the anvil trocar 6010to the center of the staple line 6003 transection may result in a highrate of anastomotic failures. This technique may be applied toultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments. Several techniques are nowdescribed for aligning the anvil trocar 6010 of the circular stapler6002 to the center “l/2” of the staple line 6003.

In one aspect, as described in FIGS. 23-25 and with reference also toFIGS. 1-11 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206, the present disclosureprovides an apparatus and method for detecting the overlapping portionof the double staple line 6004 in a laparoscopic-assisted rectal surgerycolorectal transection using a double stapling technique. Theoverlapping portion of the double staple line 6004 is detected and thecurrent location of the anvil trocar 6010 of the circular stapler 6002is displayed on a surgical hub display 215 coupled to the surgical hub206. The surgical hub display 215 displays the alignment of a circularstapler 6002 cartridge relative to the overlapping portion of the doublestaple line 6004, which is located at the center of the double stapleline 6004. The surgical hub display 215 displays a circular imagecentered around the overlapping double staple line 6004 region to ensurethat the overlapping portion of the double staple line 6004 is containedwithin the knife of the circular stapler 6002 and therefore removedfollowing the circular firing. Using the display, the surgeon aligns theanvil trocar 6010 with the center of the double staple line 6004 beforepuncturing through the center of the double staple line 6004 and/orfully clamping on the tissue before firing the circular stapler 6002 tocut out the staple overlap portion 6012 and form the anastomosis.

FIGS. 23-25 illustrate a process of aligning an anvil trocar 6010 of acircular stapler 6022 to a staple overlap portion 6012 of a doublestaple line 6004 created by a double-stapling technique, according toone aspect of the present disclosure. The staple overlap portion 6012 iscentered on the double staple line 6004 formed by a double-staplingtechnique. The circular stapler 6002 is inserted into the colon 6020below the double staple line 6004 and a laparoscope 6014 is insertedthrough the abdomen above the double staple line 6004. A laparoscope6014 and a non-contact sensor 6022 are used to determine an anvil trocar6010 location relative to the staple overlap portion 6012 of the doublestaple line 6004. The laparoscope 6014 includes an image sensor togenerate an image of the double staple line 6004. The image sensor imageis transmitted to the surgical hub 206 via the imaging module 238. Thesensor 6022 generates a signal 6024 that detects the metal staples usinginductive or capacitive metal sensing technology. The signal 6024 variesbased on the position of the anvil trocar 6010 relative to the stapleoverlap portion 6004. A centering tool 6030 presents an image 6038 ofthe double staple line 6004 and a target alignment ring 6032circumscribing the image 6038 of the double staple line 6004 centeredabout an image 6040 of the staple overlap portion 6012 on the surgicalhub display 215. The centering tool 6030 also presents a projected cutpath 6034 of an anvil knife of the circular stapler 6002. The alignmentprocess includes displaying an image 6038 of the double staple line 6004and a target alignment ring 6032 circumscribing the image 6038 of thedouble staple line 6004 centered on the image 6040 of the staple overlapportion 6012 to be cut out by the circular knife of the circular stapler6002. Also displayed is an image of a crosshair 6036 (X) relative to theimage 6040 of the staple overlap portion 6012.

FIG. 23 illustrates an anvil trocar 6010 of a circular stapler 6002 thatis not aligned with a staple overlap portion 6012 of a double stapleline 6004 created by a double-stapling technique. The double staple line6004 has a length “l” and the staple overlap portion 6012 is locatedmidway along the double staple line 6004 at “l/2.” As shown in FIG. 23,the circular stapler 6002 is inserted into a section of the colon 6020and is positioned just below the double staple line 6004 transection. Alaparoscope 6014 is positioned above the double staple line 6004transection and feeds an image of the double staple line 6004 and stapleoverlap portion 6012 within the field of view 6016 of the laparoscope6014 to the surgical hub display 215. The position of the anvil trocar6010 relative to the staple overlap portion 6012 is detected by a sensor6022 located on the circular stapler 6002. The sensor 6022 also providesthe position of the anvil trocar 6010 relative to the staple overlapportion 6012 to the surgical hub display 215.

As shown in In FIG. 23, the projected path 6018 of the anvil trocar 6010is shown along a broken line to a position marked by an X. As shown inFIG. 23, the projected path 6018 of the anvil trocar 6010 is not alignedwith the staple overlap portion 6012. Puncturing the anvil trocar 6010through the double staple line 6004 at a point off the staple overlapportion 6012 could lead to an anastomotic failure. Using the anviltrocar 6010 centering tool 6030 described in FIG. 25, the surgeon canalign the anvil trocar 6010 with the staple overlap portion 6012 usingthe images displayed by the centering tool 6030. For example, in oneimplementation, the sensor 6022 is an inductive sensor. Since the stapleoverlap portion 6012 contains more metal than the rest of the lateralportions of the double staple line 6004, the signal 6024 is maximum whenthe sensor 6022 is aligned with and proximate to the staple overlapportion 6012. The sensor 6022 provides a signal to the surgical hub 206that indicates the location of the anvil trocar 6010 relative to thestaple overlap portion 6012. The output signal is converted to avisualization of the location of the anvil trocar 6010 relative to thestaple overlap portion 6012 that is displayed on the surgical hubdisplay 215.

As shown in FIG. 24, the anvil trocar 6010 is aligned with the stapleoverlap portion 6012 at the center of the double staple line 6004created by a double-stapling technique. The surgeon can now puncture theanvil trocar 6010 through the staple overlap portion 6012 of the doublestaple line 6004 and/or fully clamp on the tissue before firing thecircular stapler 6002 to cut out the staple overlap portion 6012 andform an anastomosis.

FIG. 25 illustrates a centering tool 6030 displayed on a surgical hubdisplay 215, the centering tool providing a display of a staple overlapportion 6012 of a double staple line 6004 created by a double-staplingtechnique, where the anvil trocar 6010 is not aligned with the stapleoverlap portion 6012 of the double staple line 6004 as shown in FIG. 23.The centering tool 6030 presents an image 6038 on the surgical hubdisplay 215 of the double staple line 6004 and an image 6040 of thestaple overlap portion 6012 received from the laparoscope 6014. A targetalignment ring 6032 centered about the image 6040 of the staple overlapportion 6012 circumscribes the image 6038 of the double staple line 6004to ensure that the staple overlap portion 6012 is located within thecircumference of the projected cut path 6034 of the circular stapler6002 knife when the projected cut path 6034 is aligned to the targetalignment ring 6032. The crosshair 6036 (X) represents the location ofthe anvil trocar 6010 relative to the staple overlap portion 6012. Thecrosshair 6036 (X) indicates the point through the double staple line6004 where the anvil trocar 6010 would puncture if it were advanced fromits current location.

As shown in FIG. 25, the anvil trocar 6010 is not aligned with thedesired puncture through location designated by the image 6040 of thestaple overlap portion 6012. To align the anvil trocar 6010 with thestaple overlap portion 6012 the surgeon manipulates the circular stapler6002 until the projected cut path 6034 overlaps the target alignmentring 6032 and the crosshair 6036 (X) is centered on the image 6040 ofthe staple overlap portion 6012. Once alignment is complete, the surgeonpunctures the anvil trocar 6010 through the staple overlap portion 6012of the double staple line 6004 and/or fully clamps on the tissue beforefiring the circular stapler 6002 to cut out the staple overlap portion6012 and form the anastomosis.

As discussed above, the sensor 6022 is configured to detect the positionof the anvil trocar 6010 relative to the staple overlap portion 6012.Accordingly, the location of the crosshair 6036 (X) presented on thesurgical hub display 215 is determined by the surgical stapler sensor6022. In another aspect, the sensor 6022 may be located on thelaparoscope 6014, where the sensor 6022 is configured to detect the tipof the anvil trocar 6010. In other aspects, the sensor 6022 may belocated either on the circular stapler 6022 or the laparoscope 6014, orboth, to determine the location of the anvil trocar 6010 relative to thestaple overlap portion 6012 and provide the information to the surgicalhub display 215 via the surgical hub 206.

FIGS. 26 and 27 illustrate a before image 6042 and an after image 6043of a centering tool 6030, according to one aspect of the presentdisclosure. FIG. 26 illustrates an image of a projected cut path 6034 ofan anvil trocar 6010 and circular knife before alignment with the targetalignment ring 6032 circumscribing the image 6038 of the double stapleline 6004 over the image 6040 of the staple overlap portion 6040presented on a surgical hub display 215. FIG. 27 illustrates an image ofa projected cut path 6034 of an anvil trocar 6010 and circular knifeafter alignment with the target alignment ring 6032 circumscribing theimage 6038 of the double staple line 6004 over the image 6040 of thestaple overlap portion 6040 presented on a surgical hub display 215. Thecurrent location of the anvil trocar 6010 is marked by the crosshair6036 (X), which as shown in FIG. 26, is positioned below and to the leftof center of the image 6040 of the staple overlap portion 6040. As shownin FIG. 27, as the surgeon moves the anvil trocar 6010 of the along theprojected path 6046, the projected cut path 6034 aligns with the targetalignment ring 6032. The target alignment ring 6032 may be displayed asa greyed out alignment circle overlaid over the current position of theanvil trocar 6010 relative to the center of the double staple line 6004,for example. The image may include indication marks to assist thealignment process by indication which direction to move the anvil trocar6010. The target alignment ring 6032 may be shown in bold, change coloror may be highlighted when it is located within a predetermined distanceof center within acceptable limits.

In another aspect, the sensor 6022 may be configured to detect thebeginning and end of a linear staple line in a colorectal transectionand to provide the position of the current location of the anvil trocar6010 of the circular stapler 6002. In another aspect, the presentdisclosure provides a surgical hub display 215 to present the circularstapler 6002 centered on the linear staple line, which would create evendog ears, and to provide the current position of the anvil trocar 6010to allow the surgeon to center or align the anvil trocar 6010 as desiredbefore puncturing and/or fully clamping on tissue prior to firing thecircular stapler 6002.

In another aspect, as described in FIGS. 28-30 and with reference alsoto FIGS. 1-11 to show interaction with an interactive surgical system100 environment including a surgical hub 106, 206, in alaparoscopic-assisted rectal surgery colorectal transection using alinear stapling technique, the beginning and end of the linear stapleline 6052 is detected and the current location of the anvil trocar 6010of the circular stapler 6002 is displayed on a surgical hub display 215coupled to the surgical hub 206. The surgical hub display 215 displays acircular image centered on the double staple line 6004, which wouldcreate even dog ears and the current position of the anvil trocar 6002is displayed to allow the surgeon to center or align the anvil trocar6010 before puncturing through the linear staple line 6052 and/or fullyclamping on the tissue before firing the circular stapler 6002 to cutout the center 6050 of the linear staple line 6052 to form ananastomosis.

FIGS. 28-30 illustrate a process of aligning an anvil trocar 6010 of acircular stapler 6022 to a center 6050 of a linear staple line 6052created by a linear stapling technique, according to one aspect of thepresent disclosure. FIGS. 28 and 29 illustrate a laparoscope 6014 and asensor 6022 located on the circular stapler 6022 to determine thelocation of the anvil trocar 6010 relative to the center 6050 of thelinear staple line 6052. The anvil trocar 6010 and the sensor 6022 isinserted into the colon 6020 below the linear staple line 6052 and thelaparoscope 6014 is inserted through the abdomen above the linear stapleline 6052.

FIG. 28 illustrates the anvil trocar 6010 out of alignment with thecenter 6050 of the linear staple line 6052 and FIG. 29 illustrates theanvil trocar 6010 in alignment with the center 6050 of the linear stapleline 6052. The sensor 6022 is used to detect the center 6050 of thelinear staple line 6052 to align the anvil trocar 6010 with the centerof the staple line 6052. In one aspect, the center 6050 of the linearstaple line 6052 may be located by moving the circular stapler 6002until one end of the linear staple line 6052 is detected. An end may bedetected when there are no more staples in the path of the sensor 6022.Once one of the ends is reached, the circular stapler 6002 is movedalong the linear staple line 6053 until the opposite end is detected andthe length “

” of the linear staple line 6052 is determined by measurement or bycounting individual staples by the sensor 6022. Once the length of thelinear staple line 6052 is determined, the center 6050 of the linearstaple line 6052 can be determined by dividing the length by two “

/2.”

FIG. 30 illustrates a centering tool 6054 displayed on a surgical hubdisplay 215, the centering tool providing a display of a linear stapleline 6052, where the anvil trocar 6010 is not aligned with the stapleoverlap portion 6012 of the double staple line 6004 as shown in FIG. 28.The surgical hub display 215 presents a standard reticle field of view6056 of the laparoscopic field of view 6016 of the linear staple line6052 and a portion of the colon 6020. The surgical hub display 215 alsopresents a target ring 6062 circumscribing the image center of thelinear staple line and a projected cut path 6064 of the anvil trocar andcircular knife. The crosshair 6066 (X) represents the location of theanvil trocar 6010 relative to the center 6050 of the linear staple line6052. The crosshair 6036 (X) indicates the point through the linearstaple line 6052 where the anvil trocar 6010 would puncture if it wereadvanced from its current location.

As shown in FIG. 30, the anvil trocar 6010 is not aligned with thedesired puncture through location designated by the offset between thetarget ring 6062 and the projected cut path 6064. To align the anviltrocar 6010 with the center 6050 of the linear staple line 6052 thesurgeon manipulates the circular stapler 6002 until the projected cutpath 6064 overlaps the target alignment ring 6062 and the crosshair 6066(X) is centered on the image 6040 of the staple overlap portion 6012.Once alignment is complete, the surgeon punctures the anvil trocar 6010through the center 6050 of the linear staple line 6052 and/or fullyclamps on the tissue before firing the circular stapler 6002 to cut outthe staple overlap portion 6012 and forming the anastomosis.

In one aspect, the present disclosure provides an apparatus and methodfor displaying an image of an linear staple line 6052 using a lineartransection technique and an alignment ring or bullseye positioned as ifthe anvil trocar 6010 of the circular stapler 6022 were centeredappropriately along the linear staple line 6052. The apparatus displaysa greyed out alignment ring overlaid over the current position of theanvil trocar 6010 relative to the center 6050 of the linear staple line6052. The image may include indication marks to assist the alignmentprocess by indication which direction to move the anvil trocar 6010. Thealignment ring may be bold, change color or highlight when it is locatedwithin a predetermined distance of centered.

With reference now to FIGS. 28-31, FIG. 31 is an image 6080 of astandard reticle field view 6080 of a linear staple line 6052transection of a surgical as viewed through a laparoscope 6014 displayedon the surgical hub display 215, according to one aspect of the presentdisclosure. In a standard reticle view 6080, it is difficult to see thelinear staple line 6052 in the standard reticle field of view 6056.Further, there are no alignment aids to assist with alignment andintroduction of the anvil trocar 6010 to the center 6050 of the linearstaple line. This view does not show an alignment circle or alignmentmark to indicate if the circular stapler is centered appropriately anddoes not show the projected trocar path. In this view it also difficultto see the staples because there is no contrast with the backgroundimage.

With reference now to FIGS. 28-32, FIG. 32 is an image 6082 of alaser-assisted reticle field of view 6072 of the surgical site shown inFIG. 31 before the anvil trocar 6010 and circular knife of the circularstapler 6002 are aligned to the center 6050 of the linear staple line6052, according to one aspect of the present disclosure. Thelaser-assisted reticle field of view 6072 provides an alignment mark orcrosshair 6066 (X), currently positioned below and to the left of centerof the linear staple line 6052 showing the projected path of the anviltrocar 6010 to assist positioning of the anvil trocar 6010. In additionto the projected path marked by the crosshair 6066 (X) of the anviltrocar 6010, the image 6082 displays the staples of the linear stapleline 6052 in a contrast color to make them more visible against thebackground. The linear staple line 6052 is highlighted and a bullseyetarget 6070 is displayed over the center 6050 of the linear staple line6052. Outside of the laser-assisted reticle field of view 6072, theimage 6082 displays a status warning box 6068, a suggestion box 6074, atarget ring 6062, and the current alignment position of the anvil trocar6010 marked by the crosshair 6066 (X) relative to the center 6050 of thelinear staple line 6052. As shown in FIG. 32, the status warning box6068 indicates that the trocar is “MISALIGNED” and the suggestion box6074 states “Adjust trocar to center staple line.”

With reference now to FIGS. 28-33, FIG. 33 is an image 6084 of alaser-assisted reticle field of view 6072 of the surgical site shown inFIG. 32 after the anvil trocar 6010 and circular knife of the circularstapler 6002 are aligned to the center 6050 of the linear staple line6052, according to one aspect of the present disclosure. Thelaser-assisted reticle field of view 6072 provides an alignment mark orcrosshair 6066 (X), currently positioned below and to the left of centerof the linear staple line 6052 showing the projected path of the anviltrocar 6010 to assist positioning of the anvil trocar 6010. In additionto the projected path marked by the crosshair 6066 (X) of the anviltrocar 6010, the image 6082 displays the staples of the linear stapleline 6052 in a contrast color to make them more visible against thebackground. The linear staple line 6052 is highlighted and a bullseyetarget 6070 is displayed over the center 6050 of the linear staple line6052. Outside of the laser-assisted reticle field of view 6072, theimage 6082 displays a status warning box 6068, a suggestion box 6074, atarget ring 6062, and the current alignment position of the anvil trocar6010 marked by the crosshair 6066 (X) relative to the center 6050 of thelinear staple line 6052. As shown in FIG. 32, the status warning box6068 indicates that the trocar is “MISALIGNED” and the suggestion box6074 states “Adjust trocar to center staple line.”

FIG. 33 is a laser assisted view of the surgical site shown in FIG. 32after the anvil trocar 6010 and circular knife are aligned to the centerof the staple line 6052. In this view, inside the field of view 6072 ofthe laser-assisted reticle, the alignment mark crosshair 6066 (X) ispositioned over the center of the staple line 6052 and the highlightedbullseye target to indicate alignment of the trocar to the center of thestaple line. Outside the field of view 6072 of the laser-assistedreticle, the status warning box indicates that the trocar is “ALIGNED”and the suggestion is “Proceed trocar introduction.”

FIG. 34 illustrates a non-contact inductive sensor 6090 implementationof the non-contact sensor 6022 to determine an anvil trocar 6010location relative to the center of a staple line transection (the stapleoverlap portion 6012 of the double staple line 6004 shown in FIGS. 23-24or the center 6050 of the linear staple line 6052 shown in FIGS. 28-29,for example), according to one aspect of the present disclosure. Thenon-contact inductive sensor 6090 includes an oscillator 6092 thatdrives an inductive coil 6094 to generate an electromagnetic field 6096.As a metal target 6098, such as a metal staple, is introduced into theelectromagnetic field 6096, eddy currents 6100 induced in the target6098 oppose the electromagnetic field 6096 and the reluctance shifts andthe amplitude of the oscillator voltage 6102 drops. An amplifier 6104amplifies the oscillator voltage 6102 amplitude as it changes.

With reference now to FIGS. 1-11 to show interaction with an interactivesurgical system 100 environment including a surgical hub 106, 206 andalso to FIGS. 22-33, the inductive sensor 6090 is a non-contactelectronic sensor. It can be used for positioning and detecting metalobjects such as the metal staples in the staple lines 6003, 6004, 6052described above. The sensing range of the inductive sensor 6090 isdependent on the type of metal being detected. Because the inductivesensor 6090 is a non-contact sensor, it can detect metal objects acrossa stapled tissue barrier. The inductive sensor 6090 can be locatedeither on the circular stapler 6002 to detect staples in the staplelines 6003, 6004, 6052, detect the location of the distal end of thelaparoscope 6014, or it may be located on the laparoscope 6014 to detectthe location of the anvil trocar 6010. A processor or control circuitlocated either in the circular stapler 6002, laparoscope 6014, orcoupled to the surgical hub 206 receives signals from the inductivesensors 6090 and can be employed to display the centering tool on thesurgical hub display 215 to determine the location of the anvil trocar6010 relative to either staple overlap portion 6012 of a double stapleline 6004 or the center 6050 of a linear staple line 6052.

In one aspect, the distal end of the laparoscope 6014 may be detected bythe inductive sensor 6090 located on the circular stapler 6002. Theinductive sensor 6090 may detect a metal target 6098 positioned on thedistal end of the laparoscope 6014. Once the laparoscope 6014 is alignedwith the center 6050 of the linear staple line 6052 or the stapleoverlap portion 6012 of the double staple line 6004, a signal from theinductive sensor 6090 is transmitted to circuits that convert thesignals from the inductive sensor 6090 to present an image of therelative alignment of the laparoscope 6014 with the anvil trocar 6010 ofthe circular stapler 6002.

FIGS. 35A and 35B illustrate one aspect of a non-contact capacitivesensor 6110 implementation of the non-contact sensor 6022 to determinean anvil trocar 6010 location relative to the center of a staple linetransection (the staple overlap portion 6012 of the double staple line6004 shown in FIGS. 23-24 or the center 6050 of the linear staple line6052 shown in FIGS. 28-29, for example), according to one aspect of thepresent disclosure. FIG. 35A shows the non-contact capacitive sensor6110 without a nearby metal target and FIG. 35B shows the non-contactcapacitive sensor 6110 near a metal target 6112. The non-contactcapacitive sensor 6110 includes capacitor plates 6114, 6116 housed in asensing head and establishes field lines 6118 when energized by anoscillator waveform to define a sensing zone. FIG. 35A shows the fieldlines 6118 when no target is present proximal to the capacitor plates6114, 6116. FIG. 35B shows a ferrous or nonferrous metal target 6120 inthe sensing zone. As the metal target 6120 enters the sensing zone, thecapacitance increases causing the natural frequency to shift towards theoscillation frequency causing amplitude gain. Because the capacitivesensor 6110 is a non-contact sensor, it can detect metal objects acrossa stapled tissue barrier. The capacitive sensor 6110 can be locatedeither on the circular stapler 6002 to detect the staple lines 6004,6052 or the location of the distal end of the laparoscope 6014 or thecapacitive sensor 6110 may be located on the laparoscope 6014 to detectthe location of the anvil trocar 6010. A processor or control circuitlocated either in the circular stapler 6002, the laparoscope 6014, orcoupled to the surgical hub 206 receives signals from the capacitivesensor 6110 to present an image of the relative alignment of thelaparoscope 6014 with the anvil trocar 6010 of the circular stapler6002.

FIG. 36 is a logic flow diagram 6130 of a process depicting a controlprogram or a logic configuration for aligning a surgical instrument,according to one aspect of the present disclosure. With reference toFIGS. 1-11 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206 and also to FIGS. 22-35,the surgical hub 206 comprises a processor 244 and a memory 249 coupledto the processor 244. The memory 249 stores instructions executable bythe processor 244 to receive 6132 image data from a laparoscope imagesensor, generate 6134 a first image based on the image data, display6136 the first image on a surgical hub display 215 coupled to theprocessor 244, receive 6138 a signal from a non-contact sensor 6022, thesignal indicative of a position of a surgical device, generate a secondimage based on the signal indicative of the position of the surgicaldevice, e.g., the anvil trocar 6010 and display 6140 the second image onthe surgical hub display 215. The first image data represents a center6044, 6050 of a staple line 6004, 6052 seal. The first image representsa target corresponding to the center 6044, 6050 of the staple line 6004,6052 seal. The signal is indicative of a position of a surgical device,e.g., an anvil trocar 6010, relative to the center 6044, 6050 of thestaple line 6004, 6052 seal. The second image represents the position ofthe surgical device, e.g., an anvil trocar 6010, along a projected path6018 of the surgical device, e.g., an anvil trocar 6010, toward thecenter 6044, 6050 of the staple line 6004, 6052 seal.

In one aspect, the center 6044 of the double staple line 6004 sealdefines a staple overlap portion 6012. In another aspect, an imagesensor receives an image from a medical imaging device. In anotheraspect, the surgical device is a circular stapler 6002 comprising ananvil trocar 6010 and the non-contact sensor 6022 is configured todetect the location of the anvil trocar 6010 relative to the center 6044of the double staple line 6004 seal. In another aspect, the non-contactsensor 6022 is an inductive sensor 6090. In another aspect, thenon-contact sensor 6022 is a capacitive sensor 6110. In one aspect, thestaple line may be a linear staple line 6052 formed using a lineartransection technique.

Cooperation Between Local Instrument Displays and Paired Imaging DeviceDisplay

In one aspect, the present disclosure provides an instrument including alocal display, a hub having an operating room (OR), or operatingtheater, display separate from the instrument display. When theinstrument is linked to the surgical hub, the secondary display on thedevice reconfigures to display different information than when it isindependent of the surgical hub connection. In another aspect, someportion of the information on the secondary display of the instrument isthen displayed on the primary display of the surgical hub. In anotheraspect, image fusion allowing the overlay of the status of a device, theintegration landmarks being used to interlock several images and atleast one guidance feature are provided on the surgical hub and/orinstrument display. Techniques for overlaying or augmenting imagesand/or text from multiple image/text sources to present composite imageson a single display are described hereinbelow in connection with FIGS.45-53 and FIGS. 63-67.

In another aspect, the present disclosure provides cooperation betweenlocal instrument displays and a paired laparoscope display. In oneaspect, the behavior of a local display of an instrument changes when itsenses the connectable presence of a global display coupled to thesurgical hub. In another aspect, the present disclosure provides 360°composite top visual field of view of a surgical site to avoidcollateral structures. Each of these techniques is describedhereinbelow.

During a surgical procedure, the surgical site is displayed on a remote“primary” surgical hub display. During a surgical procedure, surgicaldevices track and record surgical data and variables (e.g., surgicalparameters) that are stored in the instrument (see FIGS. 12-19 forinstrument architectures comprising processors, memory, controlcircuits, storage, etc.). The surgical parameters include force-to-fire(FTF), force-to-close (FTC), firing progress, tissue gap, power level,impedance, tissue compression stability (creep), and the like. Usingconventional techniques during the procedure the surgeon needs to watchtwo separate displays. Providing image/text overlay is thus advantageousbecause during the procedure the surgeon can watch a single displaypresenting the overlaid image/text information.

One solution detects when the surgical device (e.g., instrument) isconnected to the surgical hub and then display a composite image on theprimary display that includes a field of view of the surgical sitereceived from a first instrument (e.g., medical imaging device such as,e.g., laparoscope, endoscope, thoracoscope, and the like) augmented bysurgical data and variables received from a second instrument (e.g., asurgical stapler) to provide pertinent images and data on the primarydisplay.

During a surgical procedure the surgical site is displayed as a narrowfield of view of a medical imaging device on the primary surgical hubdisplay. Items outside the current field of view, collateral structures,cannot be viewed without moving the medical imaging device.

One solution provides a narrow field of view of the surgical site in afirst window of the display augmented by a wide field of view of thesurgical site in a separate window of the display. This provides acomposite over head field of view mapped using two or more imagingarrays to provide an augmented image of multiple perspective views ofthe surgical site.

In one aspect, the present disclosure provides a surgical hub,comprising a processor and a memory coupled to the processor. The memorystores instructions executable by the processor to detect a surgicaldevice connection to the surgical hub, transmit a control signal to thedetected surgical device to transmit to the surgical hub surgicalparameter data associated with the detected device, receive the surgicalparameter data, receive image data from an image sensor, and display, ona display coupled to the surgical hub, an image received from the imagesensor in conjunction with the surgical parameter data received from thesurgical device.

In another aspect, the present disclosure provides a surgical hub,comprising a processor and a memory coupled to the processor. The memorystores instructions executable by the processor to receive first imagedata from a first image sensor, receive second image data from a secondimage sensor, and display, on a display coupled to the surgical hub, afirst image corresponding to the first field of view and a second imagecorresponding to the second field of view. The first image datarepresents a first field of view and the second image data represents asecond field of view.

In one aspect, the first field of view is a narrow angle field of viewand the second field of view is a wide angle field of view. In anotheraspect, the memory stores instructions executable by the processor toaugment the first image with the second image on the display. In anotheraspect, the memory stores instructions executable by the processor tofuse the first image and the second image into a third image and displaya fused image on the display. In another aspect, the fused image datacomprises status information associated with a surgical device, an imagedata integration landmark to interlock a plurality of images, and atleast one guidance parameter. In another aspect, the first image sensoris the same as the same image sensor and wherein the first image data iscaptured as a first time and the second image data is captured at asecond time.

In another aspect, the memory stores instructions executable by theprocessor to receive third image data from a third image sensor, whereinthe third image data represents a third field of view, generatecomposite image data comprising the second and third image data, displaythe first image in a first window of the display, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display, wherein the third image corresponds tothe composite image data.

In another aspect, the memory stores instructions executable by theprocessor to receive third image data from a third image sensor, whereinthe third image data represents a third field of view, fuse the secondand third image data to generate fused image data, display the firstimage in a first window of the display, wherein the first imagecorresponds to the first image data, and display a third image in asecond window of the display, wherein the third image corresponds to thefused image data.

In various aspects, the present disclosure provides a control circuit toperform the functions described above. In various aspects, the presentdisclosure provides a non-transitory computer readable medium storingcomputer readable instructions, which when executed, causes a machine toperform the functions described above.

By displaying endoscope images augmented with surgical device images onone primary surgical hub display, enables the surgeon to focus on onedisplay to obtain a field of view of the surgical site augmented withsurgical device data associated with the surgical procedure such asforce-to-fire, force-to-close, firing progress, tissue gap, power level,impedance, tissue compression stability (creep), and the like.

Displaying a narrow field of view image in a first window of a displayand a composite image of several other perspectives such as wider fieldsof view enables the surgeon to view a magnified image of the surgicalsite simultaneously with wider fields of view of the surgical sitewithout moving the scope.

In one aspect, the present disclosure provides both global and localdisplay of a device, e.g., a surgical instrument, coupled to thesurgical hub. The device displays all of its relevant menus and displayson a local display until it senses a connection to the surgical hub atwhich point a sub-set of the information is displayed only on themonitor through the surgical hub and that information is either mirroredon the device display or is no longer accessible on the device detonatedscreen. This technique frees up the device display to show differentinformation or display larger font information on the surgical hubdisplay.

In one aspect, the present disclosure provides an instrument having alocal display, a surgical hub having an operating theater (e.g.,operating room or OR) display that is separate from the instrumentdisplay. When the instrument is linked to the surgical hub, theinstrument local display becomes a secondary display and the instrumentreconfigures to display different information than when it is operatingindependent of the surgical hub connection. In another aspect, someportion of the information on the secondary display is then displayed onthe primary display in the operating theater through the surgical hub.

FIG. 37 illustrates a primary display 6200 of the surgical hub 206comprising a global display 6202 and a local instrument display 6204,according to one aspect of the present disclosure. With continuedreference to FIGS. 1-11 to show interaction with an interactive surgicalsystem 100 environment including a surgical hub 106, 206 and FIGS. 12-21for surgical hub connected instruments together with FIG. 37, the localinstrument display 6204 behavior is displayed when the instrument 235senses the connectable presence of a global display 6202 through thesurgical hub 206. The global display 6202 shows a field of view 6206 ofa surgical site 6208, as viewed through a medical imaging device suchas, for example, a laparoscope/endoscope 219 coupled to an imagingmodule 238, at the center of the surgical hub display 215, referred toherein also as a monitor, for example. The end effector 6218 portion ofthe connected instrument 235 is shown in the field of view 6206 of thesurgical site 6208 in the global display 6202. The images shown on thedisplay 237 located on an instrument 235 coupled to the surgical hub 206is shown, or mirrored, on the local instrument display 6204 located inthe lower right corner of the monitor 6200 as shown in FIG. 37, forexample. During operation, all relevant instrument and information andmenus are displayed on the display 237 located on the instrument 235until the instrument 235 senses a connection of the instrument 235 tothe surgical hub 206 at which point all or some sub-set of theinformation presented on the instrument display 237 is displayed only onthe local instrument display 6204 portion of the surgical hub display6200 through the surgical hub 206. The information displayed on thelocal instrument display 6204 may be mirrored on the display 237 locatedon the instrument 235 or may be no longer accessible on the instrumentdisplay 237 detonated screen. This technique frees up the instrument 235to show different information or to show larger font information on thesurgical hub display 6200. Several techniques for overlaying oraugmenting images and/or text from multiple image/text sources topresent composite images on a single display are described hereinbelowin connection with FIGS. 45-53 and FIGS. 63-67.

The surgical hub display 6200 provides perioperative visualization ofthe surgical site 6208. Advanced imaging identifies and visuallyhighlights 6222 critical structures such as the ureter 6220 (or nerves,etc.) and also tracks instrument proximity displays 6210 and shown onthe left side of the display 6200. In the illustrated example, theinstrument proximity displays 6210 show instrument specific settings.For example the top instrument proximity display 6212 shows settings fora monopolar instrument, the middle instrument proximity display 6214shows settings for a bipolar instrument, and the bottom instrumentproximity display 6212 shows settings for an ultrasonic instrument.

In another aspect, independent secondary displays or dedicated localdisplays can be linked to the surgical hub 206 to provide both aninteraction portal via a touchscreen display and/or a secondary screenthat can display any number of surgical hub 206 tracked data feeds toprovide a clear non-confusing status. The secondary screen may displayforce to fire (FTF), tissue gap, power level, impedance, tissuecompression stability (creep), etc., while the primary screen maydisplay only key variables to keep the feed free of clutter. Theinteractive display may be used to move the display of specificinformation to the primary display to a desired location, size, color,etc. In the illustrated example, the secondary screen displays theinstrument proximity displays 6210 on the left side of the display 6200and the local instrument display 6204 on the bottom right side of thedisplay 6200. The local instrument display 6204 presented on thesurgical hub display 6200 displays an icon of the end effector 6218,such as the icon of a staple cartridge 6224 currently in use, the size6226 of the staple cartridge 6224 (e.g., 60 mm), and an icon of thecurrent position of the knife 6228 of the end effector.

In another aspect, the display 237 located on the instrument 235displays the wireless or wired attachment of the instrument 235 to thesurgical hub 206 and the instrument's communication/recording on thesurgical hub 206. A setting may be provided on the instrument 235 toenable the user to select mirroring or extending the display to bothmonitoring devices. The instrument controls may be used to interact withthe surgical hub display of the information being sourced on theinstrument. As previously discussed, the instrument 235 may comprisewireless communication circuits to communicate wirelessly with thesurgical hub 206.

In another aspect, a first instrument coupled to the surgical hub 206can pair to a screen of a second instrument coupled to the surgical hub206 allowing both instruments to display some hybrid combination ofinformation from the two devices of both becoming mirrors of portions ofthe primary display. In yet another aspect, the primary display 6200 ofthe surgical hub 206 provides a 360° composite top visual view of thesurgical site 6208 to avoid collateral structures. For example, asecondary display of the end-effector surgical stapler may be providedwithin the primary display 6200 of the surgical hub 206 or on anotherdisplay in order to provide better perspective around the areas within acurrent the field of view 6206. These aspects are described hereinbelowin connection with FIGS. 38-40.

FIGS. 38-40 illustrate a composite overhead views of an end-effector6234 portion of a surgical stapler mapped using two or more imagingarrays or one array and time to provide multiple perspective views ofthe end-effector 6234 to enable the composite imaging of an overheadfield of view. The techniques described herein may be applied toultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments. Several techniques for overlayingor augmenting images and/or text from multiple image/text sources topresent composite images on a single display are described hereinbelowin connection with FIGS. 45-53 and FIGS. 63-67.

FIG. 38 illustrates a primary display 6200 of the surgical hub 206,according to one aspect of the present disclosure. A primary window 6230is located at the center of the screen shows a magnified or explodednarrow angle view of a surgical field of view 6232. The primary window6230 located in the center of the screen shows a magnified or narrowangle view of an end-effector 6234 of the surgical stapler grasping avessel 6236. The primary window 6230 displays knitted images to producea composite image that enables visualization of structures adjacent tothe surgical field of view 6232. A second window 6240 is shown in thelower left corner of the primary display 6200. The second window 6240displays a knitted image in a wide angle view at standard focus of theimage shown in the primary window 6230 in an overhead view. The overheadview provided in the second window 6240 enables the viewer to easily seeitems that are out of the narrow field surgical field of view 6232without moving the laparoscope, or other imaging device 239 coupled tothe imaging module 238 of the surgical hub 206. A third window 6242 isshown in the lower right corner of the primary display 6200 shows anicon 6244 representative of the staple cartridge of the end-effector6234 (e.g., a staple cartridge in this instance) and additionalinformation such as “4 Row” indicating the number of staple rows 6246and “35 mm” indicating the distance 6248 traversed by the knife alongthe length of the staple cartridge. Below the third window 6242 isdisplayed an icon 6258 of a frame of the current state of a clampstabilization sequence 6250 (FIG. 39) that indicates clampstabilization.

FIG. 39 illustrates a clamp stabilization sequence 6250 over a fivesecond period, according to one aspect of the present disclosure. Theclamp stabilization sequence 6250 is shown over a five second periodwith intermittent displays 6252, 6254, 6256, 6258, 6260 spaced apart atone second intervals 6268 in addition to providing the real time 6266(e.g., 09:35:10), which may be a pseudo real time to preserve anonymityof the patient. The intermittent displays 6252, 6254, 6256, 6258, 6260show elapsed by filling in the circle until the clamp stabilizationperiod is complete. At that point, the last display 6260 is shown insolid color. Clamp stabilization after the end effector 6234 clamps thevessel 6236 enables the formation of a better seal.

FIG. 40 illustrates a diagram 6270 of four separate wide angle viewimages 6272, 6274, 6276, 6278 of a surgical site at four separate timesduring the procedure, according to one aspect of the present disclosure.The sequence of images shows the creation of an overhead composite imagein wide and narrow focus over time. A first image 6272 is a wide angleview of the end-effector 6234 clamping the vessel 6236 taken at anearlier time t_(o) (e.g., 09:35:09). A second image 6274 is another wideangle view of the end-effector 6234 clamping the vessel 6236 taken atthe present time t₁ (e.g., 09:35:13). A third image 6276 is a compositeimage of an overhead view of the end-effector 6234 clamping the vessel6236 taken at present time t₁. The third image 6276 is displayed in thesecond window 6240 of the primary display 6200 of the surgical hub 206as shown in FIG. 38. A fourth image 6278 is a narrow angle view of theend-effector 6234 clamping the vessel 6236 at present time t₁ (e.g.,09:35:13). The fourth image 6278 is the narrow angle view of thesurgical site shown in the primary window 6230 of the primary display6200 of the surgical hub 206 as shown in FIG. 38.

Display of Instrument Specific Data Needed for Efficient Use of theEnd-Effector

In one aspect, the present disclosure provides a surgical hub display ofinstrument specific data needed for efficient use of a surgicalinstrument, such as a surgical stapler. The techniques described hereinmay be applied to ultrasonic instruments, electrosurgical instruments,combination ultrasonic/electrosurgical instruments, and/or combinationsurgical stapler/electrosurgical instruments. In one aspect, a clamptime indicator based on tissue properties is shown on the display. Inanother aspect, a 360° composite top visual view is shown on the displayto avoid collateral structures as shown and described in connection withFIGS. 37-40 is incorporated herein by reference and, for conciseness andclarity of disclosure, the description of FIGS. 37-40 will not berepeated here.

In one aspect, the present disclosure provides a display of tissue creepto provide the user with in-tissue compression/tissue stability data andto guide the user making an appropriate choice of when to conduct thenext instrument action. In one aspect, an algorithm calculates aconstant advancement of a progressive time based feedback system relatedto the viscoelastic response of tissue. These and other aspects aredescribed hereinbelow.

FIG. 41 is a graph 6280 of tissue creep clamp stabilization curves 6282,6284 for two tissue types, according to one aspect of the presentdisclosure. The clamp stabilization curves 6284, 6284 are plotted asforce-to-close (FTC) as a function of time, where FTC (N) is displayedalong the vertical axis and Time, t, (Sec) is displayed along thehorizontal axis. The FTC is the amount of force exerted to close theclamp arm on the tissue. The first clamp stabilization curve 6282represents stomach tissue and the second clamp stabilization curve 6284represents lung tissue. In one aspect, the FTC along the vertical axisis scaled from 0-180 N. and the horizontal axis is scaled from 0-5 Sec.As shown, the FTC as a different profile over a five second clampstabilization period (e.g., as shown in FIG. 39).

With reference to the first clamp stabilization curve 6282, as thestomach tissue is clamped by the end-effector 6234, the force-to-close(FTC) applied by the end-effector 6234 increases from 0 N to a peakforce-to-close of ˜180 N after ˜1 Sec. While the end-effector 6234remains clamped on the stomach tissue, the force-to-close decays andstabilizes to ˜150 N over time due to tissue creep.

Similarly, with reference to the second clamp stabilization curve 6284,as the lung tissue is clamped by the end-effector 6234, theforce-to-close applied by the end-effector 6234 increases from 0 N to apeak force-to-close of ˜90 N after just less than ˜1 Sec. While theend-effector 6234 remains clamped on the lung tissue, the force-to-closedecays and stabilizes to ˜60 N over time due to tissue creep.

The end-effector 6234 clamp stabilization is monitored as describedabove in connection with FIGS. 38-40 and is displayed every secondcorresponding the sampling times t₁, t₂, t₃, t₄, t₅ of theforce-to-close to provide user feedback regarding the state of theclamped tissue. FIG. 41 shows an example of monitoring tissuestabilization for the lung tissue by sampling the force-to-close everysecond over a 5 seconds period. At each sample time t₁, t₂, t₃, t₄, t₅,the instrument 235 or the surgical hub 206 calculates a correspondingvector tangent 6288, 6292, 6294, 6298, 6302 to the second clampstabilization curve 6284. The vector tangent 6288, 6292, 6294, 6298,6302 is monitored until its slope drops below a threshold to indicatethat the tissue creep is complete and the tissue is ready to sealed andcut. As shown in FIG. 41, the lung tissue is ready to be sealed and cutafter ˜5 Sec. clamp stabilization period, where a solid gray circle isshown at sample time 6300. As shown, the vector tangent 6302 is lessthan a predetermined threshold.

The equation of a vector tangent 6288, 6292, 6294, 6298, 6302 to theclamp stabilization curve 6284 may be calculated using differentialcalculus techniques, for example. In one aspect, at a given point on theclamp stabilization curve 6284, the gradient of the curve 6284 is equalto the gradient of the tangent to the curve 6284. The derivative (orgradient function) describes the gradient of the curve 6284 at any pointon the curve 6284. Similarly, it also describes the gradient of atangent to the curve 6284 at any point on the curve 6284. The normal tothe curve 6284 is a line perpendicular to the tangent to the curve 6284at any given point. To determine the equation of a tangent to a curvefind the derivative using the rules of differentiation. Substitute the xcoordinate (independent variable) of the given point into the derivativeto calculate the gradient of the tangent. Substitute the gradient of thetangent and the coordinates of the given point into an appropriate formof the straight line equation. Make the y coordinate (dependentvariable) the subject of the formula.

FIG. 42 is a graph 6310 of time dependent proportionate fill of a clampforce stabilization curve, according to one aspect of the presentdisclosure. The graph 6310 includes clamp stabilization curves 6312,6314, 6316 for standard thick stomach tissue, thin stomach tissue, andstandard lung tissue. The vertical axis represents FTC (N) scaled from0-240 N and the horizontal axis represents Time, t, (Sec) scaled from0-15 Sec. As shown, the standard thick stomach tissue curve 6316 is thedefault force decay stability curve. All three clamp stabilizationcurves 6312, 6314, 6316 FTC profiles reach a maximum force shortly afterclamping on the tissue and then the FTC decreases over time until iteventually stabilizes due to the viscoelastic response of the tissue. Asshown the standard lung tissue clamp stabilization curve 6312 stabilizesafter a period of ˜5 Sec., the thin stomach tissue clamp stabilizationcurve 6314 stabilizes after a period of ˜10 Sec., and the thick stomachtissue clamp stabilization curve 6316 stabilizes after a period of ˜15Sec.

FIG. 43 is a graph 6320 of the role of tissue creep in the clamp forcestabilization curve 6322, according to one aspect of the presentdisclosure. The vertical axis represents force-to-close FTC (N) and thehorizontal axis represents Time, t, (Sec) in seconds. Vector tangentangles dθ₁, dθ₂ . . . dθ_(n) are measured at each force-to-closesampling (t₀, t₁, t₂, t₃, t₄, etc.) times. The vector tangent angledθ_(n) is used to determine when the tissue has reached the creeptermination threshold, which indicates that the tissue has reached creepstability.

FIGS. 44A and 44B illustrate two graphs 6330, 6340 for determining whenthe clamped tissue has reached creep stability, according to one aspectof the present disclosure. The graph 6330 in FIG. 44A illustrates acurve 6332 that represents a vector tangent angle dθ as a function oftime. The vector tangent angle dθ is calculated as discussed in FIG. 43.The horizontal line 6334 is the tissue creep termination threshold. Thetissue creep is deemed to be stable at the intersection 6336 of thevector tangent angle dθ curve 6332 and the tissue creep terminationthreshold 6334. The graph 6340 in FIG. 44B illustrates a ΔFTC curve 6342that represents ΔFTC as a function of time. The ΔFTC curve 6342illustrates the threshold 6344 to 100% complete tissue creep stabilitymeter. The tissue creep is deemed to be stable at the intersection 6346of the ΔFTC curve 6342 and the threshold 6344.

COMMUNICATION TECHNIQUES

With reference to FIGS. 1-11 to show interaction with an interactivesurgical system 100 environment including a surgical hub 106, 206, andin particular, FIGS. 9-10, in various aspects, the present disclosureprovides communications techniques for exchanging information between aninstrument 235, or other modules, and the surgical hub 206. In oneaspect, the communications techniques include image fusion to placeinstrument status and analysis over a laparoscope image, such as ascreen overlay of data, within and around the perimeter of an imagepresented on a surgical hub display 215, 217. In another aspect, thecommunication techniques include combining an intermediate short rangewireless, e.g., Bluetooth, signal with the image, and in another aspect,the communication techniques include applying security andidentification of requested pairing. In yet another aspect, thecommunication techniques include an independent interactive headset wornby a surgeon that links to the hub with audio and visual informationthat avoids the need for overlays, but allows customization of displayedinformation around periphery of view. Each of these communicationtechniques is discussed hereinbelow.

Screen Overlay of Data within and Around the Perimeter of the DisplayedImage

In one aspect, the present disclosure provides image fusion allowing theoverlay of the status of a device, the integration landmarks being usedto interlock several images, and at least one guidance feature. Inanother aspect, the present disclosure provides a technique for screenoverlay of data within and around the perimeter of displayed image.Radiographic integration may be employed for live internal sensing andpre-procedure overlay. Image fusion of one source may be superimposedover another. Image fusion may be employed to place instrument statusand analysis on a medical imaging device (e.g., laparoscope, endoscope,thoracoscope, etc.) image. Image fusion allows the overlay of the statusof a device or instrument, integration landmarks to interlock severalimages, and at least one guidance feature.

FIG. 45 illustrates an example of an augmented video image 6350comprising a pre-operative video image 6352 augmented with data 6354,6356, 6358 identifying displayed elements. An augmented reality visionsystem may be employed in surgical procedures to implement a method foraugmenting data onto a pre-operative image 6352. The method includesgenerating a pre-operative image 6352 of an anatomical section of apatient and generating an augmented video image of a surgical sitewithin the patient. The augmented video image 6350 includes an image ofat least a portion of a surgical tool 6354 operated by a user 6456. Themethod further includes processing the pre-operative image 6352 togenerate data about the anatomical section of the patient. The dataincludes a label 6358 for the anatomical section and a peripheral marginof at least a portion of the anatomical section. The peripheral marginis configured to guide a surgeon to a cutting location relative to theanatomical section, embedding the data and an identity of the user 6356within the pre-operative image 6350 to display an augmented video image6350 to the user about the anatomical section of the patient. The methodfurther includes sensing a loading condition on the surgical tool 6354,generating a feedback signal based on the sensed loading condition, andupdating, in real time, the data and a location of the identity of theuser operating the surgical tool 6354 embedded within the augmentedvideo image 6350 in response to a change in a location of the surgicaltool 6354 within the augmented video image 6350. Further examples aredisclosed in U.S. Pat. No. 9,123,155, titled APPARATUS AND METHOD FORUSING AUGMENTED REALITY VISION SYSTEM IN SURGICAL PROCEDURES, whichissued on Sep. 1, 2015, which is herein incorporated by reference in itsentirety.

In another aspect, radiographic integration techniques may be employedto overlay the pre-operative image 6352 with data obtained through liveinternal sensing or pre-procedure techniques. Radiographic integrationmay include marker and landmark identification using surgical landmarks,radiographic markers placed in or outside the patient, identification ofradio-opaque staples, clips or other tissue-fixated items. Digitalradiography techniques may be employed to generate digital images foroverlaying with a pre-operative image 6352. Digital radiography is aform of X-ray imaging that employs a digital image capture device withdigital X-ray sensors instead of traditional photographic film. Digitalradiography techniques provide immediate image preview and availabilityfor overlaying with the pre-operative image 6352. In addition, specialimage processing techniques can be applied to the digital X-ray mages toenhance the overall display quality of the image.

Digital radiography techniques employ image detectors that include flatpanel detectors (FPDs), which are classified in two main categoriesindirect FPDs and direct FPDs. Indirect FPDs include amorphous silicon(a-Si) combined with a scintillator in the detector's outer layer, whichis made from cesium iodide (CsI) or gadolinium oxy-sulfide (Gd2O2S),converts X-rays to light. The light is channeled through the a-Siphotodiode layer where it is converted to a digital output signal. Thedigital signal is then read out by thin film transistors (TFTs) orfiber-coupled charge coupled devices (CODs). Direct FPDs includeamorphous selenium (a-Se) FPDs that convert X-ray photons directly intocharge. The outer layer of a flat panel in this design is typically ahigh-voltage bias electrode. X-ray photons create electron-hole pairs ina-Se, and the transit of these electrons and holes depends on thepotential of the bias voltage charge. As the holes are replaced withelectrons, the resultant charge pattern in the selenium layer is readout by a TFT array, active matrix array, electrometer probes or microplasma line addressing. Other direct digital detectors are based on CMOSand CCD technology. Phosphor detectors also may be employed to recordthe X-ray energy during exposure and is scanned by a laser diode toexcite the stored energy which is released and read out by a digitalimage capture array of a CCD.

FIG. 46 is a logic flow diagram 6360 of a process depicting a controlprogram or a logic configuration to display images, according to oneaspect of the present disclosure. With reference also to FIGS. 1-11 toshow interaction with an interactive surgical system 100 environmentincluding a surgical hub 106, 206, the present disclosure provides, inone aspect, a surgical hub 206, comprising a processor 244 and a memory249 coupled to the processor 244. The memory 249 stores instructionsexecutable by the processor 244 to receive 6362 first image data from afirst image sensor, receive 6364 second image data from a second imagesensor, and display 6366, on a display 217 coupled to the surgical hub206, a first image corresponding to the first field of view and a secondimage corresponding to the second field of view. The first image datarepresents a first field of view and the second image data represents asecond field of view.

In one aspect, the first field of view is a narrow angle field of viewand the second field of view is a wide angle field of view. In anotheraspect, the memory 249 stores instructions executable by the processor244 to augment the first image with the second image on the display. Inanother aspect, the memory 249 stores instructions executable by theprocessor 244 to fuse the first image and the second image into a thirdimage and display a fused image on the display 217. In another aspect,the fused image data comprises status information associated with asurgical device 235, an image data integration landmark to interlock aplurality of images, and at least one guidance parameter. In anotheraspect, the first image sensor is the same as the same image sensor andwherein the first image data is captured as a first time and the secondimage data is captured at a second time.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive third image data from a third image sensor,wherein the third image data represents a third field of view, generatecomposite image data comprising the second and third image data, displaythe first image in a first window of the display, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display 215, wherein the third image correspondsto the composite image data.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive third image data from a third image sensor,wherein the third image data represents a third field of view, fuse thesecond and third image data to generate fused image data, display thefirst image in a first window of the display 217, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display 217, wherein the third image correspondsto the fused image data.

Intermediate Short Range Wireless (e.g., Bluetooth) Signal Combiner

An intermediate short range wireless, e.g., Bluetooth, signal combinermay comprise a wireless heads-up display adapter placed into thecommunication path of the monitor to a laparoscope console allowing thesurgical hub to overlay data onto the screen. Security andidentification of requested pairing may augment the communicationtechniques.

FIG. 47 illustrates a communication system 6370 comprising anintermediate signal combiner 6372 positioned in the communication pathbetween an imaging module 238 and a surgical hub display 217, accordingto one aspect of the present disclosure. The signal combiner 6372receives image data from an imaging module 238 in the form of shortrange wireless or wired signals. The signal combiner 6372 also receivesaudio and image data form a headset 6374 and combines the image datafrom the imaging module 238 with the audio and image data from theheadset 6374. The surgical hub 206 receives the combined data from thecombiner 6372 and overlays the data provided to the display 217, wherethe overlaid data is displayed. The signal combiner 6372 may communicatewith the surgical hub 206 via wired or wireless signals. The headset6374 receives image data from an imaging device 6376 coupled to theheadset 6374 and receives audio data from an audio device 6378 coupledto the headset 6374. The imaging device 6376 may be a digital videocamera and the audio device 6378 may be a microphone. In one aspect, thesignal combiner 6372 may be an intermediate short range wireless, e.g.,Bluetooth, signal combiner. The signal combiner 6374 may comprise awireless heads-up display adapter to couple to the headset 6374 placedinto the communication path of the display 217 to a console allowing thesurgical hub 206 to overlay data onto the screen of the display 217.Security and identification of requested pairing may augment thecommunication techniques. The imaging module 238 may be coupled to avariety if imaging devices such as an endoscope 239, laparoscope, etc.,for example.

Independent Interactive Headset

FIG. 48 illustrates an independent interactive headset 6380 worn by asurgeon 6382 to communicate data to the surgical hub, according to oneaspect of the present disclosure. Peripheral information of theindependent interactive headset 6380 does not include active video.Rather, the peripheral information includes only device settings, orsignals that do not have same demands of refresh rates. Interaction mayaugment the surgeon's 6382 information based on linkage withpreoperative computerized tomography (CT) or other data linked in thesurgical hub 206. The independent interactive headset 6380 can identifystructure—ask whether instrument is touching a nerve, vessel, oradhesion, for example. The independent interactive headset 6380 mayinclude pre-operative scan data, an optical view, tissue interrogationproperties acquired throughout procedure, and/or processing in thesurgical hub 206 used to provide an answer. The surgeon 6382 can dictatenotes to the independent interactive headset 6380 to be saved withpatient data in the hub storage 248 for later use in report or in followup.

In one aspect, the independent interactive headset 6380 worn by thesurgeon 6382 links to the surgical hub 206 with audio and visualinformation to avoid the need for overlays, and allows customization ofdisplayed information around periphery of view. The independentinteractive headset 6380 provides signals from devices (e.g.,instruments), answers queries about device settings, or positionalinformation linked with video to identify quadrant or position. Theindependent interactive headset 6380 has audio control and audiofeedback from the headset 6380. The independent interactive headset 6380is still able to interact with all other systems in the operatingtheater (e.g., operating room), and have feedback and interactionavailable wherever the surgeon 6382 is viewing.

Identification and Usage Recording

In one aspect, the present disclosure provides a display of theauthenticity of reloads, modular components, or loading units. FIG. 49illustrates a method 6390 for controlling the usage of a device 6392. Adevice 6392 is connected to an energy source 6394. The device 6392includes a memory device 6396 that includes storage 6398 andcommunication 6400 devices. The storage 6398 includes data 6402 that maybe locked data 6404 or unlocked data 6406. Additionally, the storage6398 includes an error-detecting code 6408 such as a cyclic redundancycheck (CRC) value and a sterilization indicator 6410. The energy source6394 includes a reader 6412, display 6414, a processor 6416, and a dataport 6418 that couples the energy source 6394 to a network 6420. Thenetwork 6420 is coupled to a central server 6422, which is coupled to acentral database 6424. The network 6420 also is coupled to areprocessing facility 6426. The reprocessing facility 6426 includes areprocessing data reader/writer 6428 and a sterilizing device 6430.

The method comprises connecting the device to an energy source 6394.Data is read from a memory device 6396 incorporated in the device 6392.The data including one or more of a unique identifier (UID), a usagevalue, an activation value, a reprocessing value, or a sterilizationindicator. The usage value is incremented when the device 6392 isconnected to the energy source 6394. The activation value is incrementedwhen the device 6392 is activated permitting energy to flow from theenergy source 6394 to an energy consuming component of the device 6392.Usage of the device 6392 may be prevented if: the UID is on a list ofprohibited UIDs, the usage value is not lower than a usage limitationvalue, the reprocessing value is equal to a reprocessing limitationvalue, the activation value is equal to an activation limitation value,and/or the sterilization indicator does not indicate that the device hasbeen sterilized since its previous usage. Further examples are disclosedin U.S. Patent Application Publication No. 2015/0317899, titled SYSTEMAND METHOD FOR USING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES,which published on Nov. 5, 2015, which is herein incorporated byreference in its entirety.

FIG. 50 provides a surgical system 6500 in accordance with the presentdisclosure and includes a surgical instrument 6502 that is incommunication with a console 6522 or a portable device 6526 through alocal area network 6518 or a cloud network 6520 via a wired or wirelessconnection. In various aspects, the console 6522 and the portable device6526 may be any suitable computing device. The surgical instrument 6502includes a handle 6504, an adapter 6508, and a loading unit 6514. Theadapter 6508 releasably couples to the handle 6504 and the loading unit6514 releasably couples to the adapter 6508 such that the adapter 6508transmits a force from a drive shaft to the loading unit 6514. Theadapter 6508 or the loading unit 6514 may include a force gauge (notexplicitly shown) disposed therein to measure a force exerted on theloading unit 6514. The loading unit 6514 includes an end effector 6530having a first jaw 6532 and a second jaw 6534. The loading unit 6514 maybe an in-situ loaded or multi-firing loading unit (MFLU) that allows aclinician to fire a plurality of fasteners multiple times withoutrequiring the loading unit 6514 to be removed from a surgical site toreload the loading unit 6514.

The first and second jaws 6532, 6534 are configured to clamp tissuetherebetween, fire fasteners through the clamped tissue, and sever theclamped tissue. The first jaw 6532 may be configured to fire at leastone fastener a plurality of times, or may be configured to include areplaceable multi-fire fastener cartridge including a plurality offasteners (e.g., staples, clips, etc.) that may be fired more that onetime prior to being replaced. The second jaw 6534 may include an anvilthat deforms or otherwise secures the fasteners about tissue as thefasteners are ejected from the multi-fire fastener cartridge.

The handle 6504 includes a motor that is coupled to the drive shaft toaffect rotation of the drive shaft. The handle 6504 includes a controlinterface to selectively activate the motor. The control interface mayinclude buttons, switches, levers, sliders, touchscreen, and any othersuitable input mechanisms or user interfaces, which can be engaged by aclinician to activate the motor.

The control interface of the handle 6504 is in communication with acontroller 6528 of the handle 6504 to selectively activate the motor toaffect rotation of the drive shafts. The controller 6528 is disposedwithin the handle 6504 and is configured to receive input from thecontrol interface and adapter data from the adapter 6508 or loading unitdata from the loading unit 6514. The controller 6528 analyzes the inputfrom the control interface and the data received from the adapter 6508and/or loading unit 6514 to selectively activate the motor. The handle6504 may also include a display that is viewable by a clinician duringuse of the handle 6504. The display is configured to display portions ofthe adapter or loading unit data before, during, or after firing of theinstrument 6502.

The adapter 6508 includes an adapter identification device 6510 disposedtherein and the loading unit 6514 includes a loading unit identificationdevice 6516 disposed therein. The adapter identification device 6510 isin communication with the controller 6528, and the loading unitidentification device 6516 is in communication with the controller 6528.It will be appreciated that the loading unit identification device 6516may be in communication with the adapter identification device 6510,which relays or passes communication from the loading unitidentification device 6516 to the controller 6528.

The adapter 6508 may also include a plurality of sensors 6512 (oneshown) disposed thereabout to detect various conditions of the adapter6508 or of the environment (e.g., if the adapter 6508 is connected to aloading unit, if the adapter 6508 is connected to a handle, if the driveshafts are rotating, the torque of the drive shafts, the strain of thedrive shafts, the temperature within the adapter 6508, a number offirings of the adapter 6508, a peak force of the adapter 6508 duringfiring, a total amount of force applied to the adapter 6508, a peakretraction force of the adapter 6508, a number of pauses of the adapter6508 during firing, etc.). The plurality of sensors 6512 provides aninput to the adapter identification device 6510 in the form of datasignals. The data signals of the plurality of sensors 6512 may be storedwithin, or be used to update the adapter data stored within, the adapteridentification device 6510. The data signals of the plurality of sensors6512 may be analog or digital. The plurality of sensors 6512 may includea force gauge to measure a force exerted on the loading unit 6514 duringfiring.

The handle 6504 and the adapter 6508 are configured to interconnect theadapter identification device 6510 and the loading unit identificationdevice 6516 with the controller 6528 via an electrical interface. Theelectrical interface may be a direct electrical interface (i.e., includeelectrical contacts that engage one another to transmit energy andsignals therebetween). Additionally or alternatively, the electricalinterface may be a non-contact electrical interface to wirelesslytransmit energy and signals therebetween (e.g., inductively transfer).It is also contemplated that the adapter identification device 6510 andthe controller 6528 may be in wireless communication with one anothervia a wireless connection separate from the electrical interface.

The handle 6504 includes a transmitter 6506 that is configured totransmit instrument data from the controller 6528 to other components ofthe system 6500 (e.g., the LAN 6518, the cloud 6520, the console 6522,or the portable device 6526). The transmitter 6506 also may receive data(e.g., cartridge data, loading unit data, or adapter data) from theother components of the system 6500. For example, the controller 6528may transmit instrument data including a serial number of an attachedadapter (e.g., adapter 6508) attached to the handle 6504, a serialnumber of a loading unit (e.g., loading unit 6514) attached to theadapter, and a serial number of a multi-fire fastener cartridge (e.g.,multi-fire fastener cartridge), loaded into the loading unit, to theconsole 6528. Thereafter, the console 6522 may transmit data (e.g.,cartridge data, loading unit data, or adapter data) associated with theattached cartridge, loading unit, and adapter, respectively, back to thecontroller 6528. The controller 6528 can display messages on the localinstrument display or transmit the message, via transmitter 6506, to theconsole 6522 or the portable device 6526 to display the message on thedisplay 6524 or portable device screen, respectively.

Multi-Functional Surgical Control System and Switching Interface forVerbal Control of Imaging Device

FIG. 51 illustrates a verbal AESOP camera positioning system. Furtherexamples are disclosed in U.S. Pat. No. 7,097,640, titledMULTI-FUNCTIONAL SURGICAL CONTROL SYSTEM AND SWITCHING INTERFACE, whichissued on Aug. 29, 2006, which is herein incorporated by reference inits entirety. FIG. 51 shows a surgical system 6550 that may be coupledto surgical hub 206, described in connection with FIGS. 1-11. The system6550 allows a surgeon to operate a number of different surgical devices6552, 6554, 6556, and 6558 from a single input device 6560. Providing asingle input device reduces the complexity of operating the variousdevices and improves the efficiency of a surgical procedure performed bya surgeon. The system 6550 may be adapted and configured to operate apositioning system for an imaging device such as a camera or endoscopeusing verbal commands.

The surgical device 6552 may be a robotic arm which can hold and move asurgical instrument. The arm 6552 may be a device such as that sold byComputer Motion, Inc. of Goleta, Calif. under the trademark AESOP, whichis an acronym for Automated Endoscopic System for Optimal Positioning.The arm 6552 is commonly used to hold and move an endoscope within apatient. The system 6550 allows the surgeon to control the operation ofthe robotic arm 6552 through the input device 6560.

The surgical device 6554 may be an electrocautery device. Electrocauterydevices typically have a bi-polar tip which carries a current that heatsand denatures tissue. The device is typically coupled to an on-offswitch to actuate the device and heat the tissue. The electrocauterydevice may also receive control signals to vary its power output. Thesystem 6550 allows the surgeon to control the operation of theelectrocautery device through the input device 6560.

The surgical device 6556 may be a laser. The laser 6556 may be actuatedthrough an on-off switch. Additionally, the power of the laser 6556 maybe controlled by control signals. The system 6550 allows the surgeon tocontrol the operation of the laser 6556 through the input device 6560.

The device 6558 may be an operating table. The operating table 6558 maycontain motors and mechanisms which adjust the position of the table.The present invention allows the surgeon to control the position of thetable 6558 through the input device 6560. Although four surgical devices6552, 6554, 6556, and 6558 are described, it is to be understood thatother functions within the operating room may be controlled through theinput device 6560. By way of example, the system 6560 may allow thesurgeon to control the lighting and temperature of the operating roomthrough the input device 6560.

The input device 6560 may be a foot pedal which has a plurality ofbuttons 6562, 6564, 6565, 6566, and 6568 that can be depressed by thesurgeon. Each button is typically associated with a specific controlcommand of a surgical device. For example, when the input device 6560 iscontrolling the robotic arm 6552, depressing the button 6562 may movethe arm in one direction and depressing the button 6566 may move the armin an opposite direction. Likewise, when the electrocautery device 6554or the laser 6556 is coupled to the input device 6560, depressing thebutton 6568 may energize the devices, and so forth and so on. Although afoot pedal is shown and described, it is to be understood that the inputdevice 6560 may be a hand controller, a speech interface which acceptsvoice commands from the surgeon, a cantilever pedal or other inputdevices which may be well known in the art of surgical device control.Using the speech interface, the surgeon is able to position a camera orendoscope connected to the robotic arm 6552 using verbal commands. Theimaging device, such as a camera or endoscope, may be coupled to therobotic arm 6552 positioning system that be controlled through thesystem 6550 using verbal commands.

The system 6550 has a switching interface 6570 which couples the inputdevice 6560 to the surgical devices 6552, 6554, 6556, and 6558. Theinterface 6570 has an input channel 6572 which is connected to the inputdevice 6560 by a bus 6574. The interface 6570 also has a plurality ofoutput channels 6576, 6578, 6580, and 6582 that are coupled to thesurgical devices by busses 6584, 6586, 6588, 6590, 6624, 6626, 6628 andwhich may have adapters or controllers disposed in electricalcommunication therewith and therebetween. Such adapters and controllerswill be discussed in more detail hereinbelow.

Because each device 6552, 6554, 6556, 6558 may require specificallyconfigured control signals for proper operation, adapters 6620, 6622 ora controller 6618 may be placed intermediate and in electricalcommunication with a specific output channel and a specific surgicaldevice. In the case of the robotic arm system 6552, no adapter isnecessary and as such, the robotic arm system 6552 may be in directconnection with a specific output channel. The interface 6570 couplesthe input channel 6572 to one of the output channels 6576, 6578, 6580,and 6582.

The interface 6570 has a select channel 6592 which can switch the inputchannel 6572 to a different output channel 6576, 6578, 6580, or 6582 sothat the input device 6560 can control any of the surgical devices. Theinterface 6570 may be a multiplexor circuit constructed as an integratedcircuit and placed on an ASIC. Alternatively, the interface 6570 may bea plurality of solenoid actuated relays coupled to the select channel bya logic circuit. The interface 6570 switches to a specific outputchannel in response to an input signal or switching signal applied onthe select channel 6592.

As depicted in FIG. 51, there may be several inputs to the selectchannel 6592. Such inputs originate from the foot pedal 6560, the speechinterface 6600 and the CPU 6662. The interface 6570 may have amultiplexing unit such that only one switching signal may be received atthe select channel 6592 at any one time, thus ensuring no substantialhardware conflicts. The prioritization of the input devices may beconfigured so the foot pedal has highest priority followed by the voiceinterface and the CPU. This is intended for example as theprioritization scheme may be employed to ensure the most efficientsystem. As such other prioritization schemes may be employed. The selectchannel 6592 may sequentially connect the input channel to one of theoutput channels each time a switching signal is provided to the selectchannel 6592. Alternatively, the select channel 6592 may be addressableso that the interface 6570 connects the input channel to a specificoutput channel when an address is provided to the select channel 6592.Such addressing is known in the art of electrical switches.

The select channel 6592 may be connected by line 6594 to a dedicatedbutton 6596 on the foot pedal 6560. The surgeon can switch surgicaldevices by depressing the button 6596. Alternatively, the select channel6592 may be coupled by line 6598 to a speech interface 6600 which allowsthe surgeon to switch surgical devices with voice commands.

The system 6550 may have a central processing unit (CPU) 6602 whichreceives input signals from the input device 6560 through the interface6570 and a bus 6585. The CPU 6602 receives the input signals, and canensure that no improper commands are being input at the controller. Ifthis occurs, the CPU 6602 may respond accordingly, either by sending adifferent switching signal to select channel 6592, or by alerting thesurgeon via a video monitor or speaker.

The CPU 6602 can also provide output commands for the select channel6592 on the bus 6608 and receives input commands from the speechinterface 6600 on the same bi-directional bus 6608. The CPU 6602 may becoupled to a monitor 6610 and/or a speaker 6612 by buses 6614 and 6616,respectively. The monitor 6610 may provide a visual indication of whichsurgical device is coupled to the input device 6560. The monitor mayalso provide a menu of commands which can be selected by the surgeoneither through the speech interface 6600 or button 6596. Alternatively,the surgeon could switch to a surgical device by selecting a commandthrough a graphic user interface. The monitor 6610 may also provideinformation regarding improper control signals sent to a specificsurgical device 6552, 6554, 6556, 6558 and recognized by the CPU 6602.Each device 6552, 6554, 6556, 6558 has a specific appropriate operatingrange, which is well known to the skilled artisan. As such, the CPU 6602may be programmed to recognize when the requested operation from theinput device 6560 is inappropriate and will then alert the surgeoneither visually via the monitor 6610 or audibly via the speaker 6612.The speaker 6612 may also provide an audio indication of which surgicaldevice is coupled to the input device 6560.

The system 6550 may include a controller 6618 which receives the inputsignals from the input device 6560 and provides corresponding outputsignals to control the operating table 6558. Likewise, the system mayhave adapters 6620, 6622 which provide an interface between the inputdevice 6560 and the specific surgical instruments connected to thesystem.

In operation, the interface 6570 initially couples the input device 6560to one of the surgical devices. The surgeon can control a differentsurgical device by generating an input command that is provided to theselect channel 6592. The input command switches the interface 6570 sothat the input device 6560 is coupled to a different output channel andcorresponding surgical device or adapter. What is thus provided is aninterface 6570 that allows a surgeon to select, operate and control aplurality of different surgical devices through a common input device6560.

FIG. 52 illustrates a multi-functional surgical control system 6650 andswitching interface for virtual operating room integration. A virtualcontrol system for controlling surgical equipment in an operating roomwhile a surgeon performs a surgical procedure on a patient, comprising:a virtual control device including an image of a control device locatedon a surface and a sensor for interrogating contact interaction of anobject with the image on the surface, the virtual control devicedelivering an interaction signal indicative of the contact interactionof the object with the image; and a system controller connected toreceive the interaction signal from the virtual control device and todeliver a control signal to the surgical equipment in response to theinteraction signal to control the surgical equipment in response to thecontact interaction of the object with the image. Further examples aredisclosed in U.S. Pat. No. 7,317,955, titled VIRTUAL OPERATING ROOMINTEGRATION, which issued on Jan. 8, 2008, which is herein incorporatedby reference in its entirety.

As shown in FIG. 52, communication links 6674 are established betweenthe system controller 6676 and the various components and functions ofthe virtual control system 6650. The communication links 6674 arepreferably optical paths, but the communication links may also be formedby radio frequency transmission and reception paths, hardwiredelectrical connections, or combinations of optical, radio frequency andhardwired connection paths as may be appropriate for the type ofcomponents and functions obtained by those components. The arrows at theends of the links 6674 represent the direction of primary informationflow.

The communication links 6674 with the surgical equipment 6652, a virtualcontrol panel 6556, a virtual foot switch 6654 and patient monitoringequipment 6660 are bidirectional, meaning that the information flows inboth directions through the links 6674 connecting those components andfunctions. For example, the system controller 6676 supplies signalswhich are used to create a control panel image from the virtual controlpanel 6656 and a foot switch image from the virtual foot switch 6654.The virtual control panel 6656 and the virtual foot switch 6654 supplyinformation to the system controller 6676 describing the physicalinteraction of the surgeon's finger and foot relative to a projectedcontrol panel image and the projected foot switch image. The systemcontroller 6676 responds to the information describing the physicalinteraction with the projected image, and supplies control signals tothe surgical equipment 6652 and patient monitoring equipment 6660 tocontrol functionality of those components in response to the physicalinteraction information. The control, status and functionalityinformation describing the surgical equipment 6652 and patientmonitoring equipment 6660 flows to the system controller 6676, and afterthat information is interpreted by the system controller 6676, it isdelivered to a system display 6670, a monitor 6666, and/or a heads updisplay 6668 for presentation.

The communication links 6674 between the system controller 6676 and thesystem display 6670, the heads up display 6668, the monitor 6666, a tagprinter 6658 and output devices 6664 are all uni-directional, meaningthat the information flows from the system controller 6676 to thosecomponents and functions. In a similar manner, the communication links6674 between the system controller 6676 and a scanner 6672 and the inputdevices 6662 are also unidirectional, but the information flows from thecomponents 6662, 6672 to the system controller 6676. In certaincircumstances, certain control and status information may flow betweenthe system controller 6676 and the components 6658, 6660, 6662, 6664,6666, 6668, 6670, 6672 in order to control the functionality of thethose components.

Each communication link 6674 preferably has a unique identity so thatthe system controller 6676 can individually communicate with each of thecomponents of the virtual control system 6650. The unique identity ofeach communication link is preferable when some or all of thecommunication links 6674 are through the same medium, as would be thecase of optical and radio frequency communications. The unique identityof each communication link 6674 assures that the system controller 6676has the ability to exercise individual control over each of thecomponents and functions on a very rapid and almost simultaneous manner.The unique identity of each communication link 6674 can be achieved byusing different frequencies for each communication link 6674 or by usingunique address and identification codes associated with thecommunications transferred over each communication link 6674.

In one aspect, the present disclosure provides illustrates a surgicalcommunication and control headset that interfaces with the surgical hub206 described in connection with FIGS. 1-11. Further examples aredisclosed in U.S. Patent Application Publication No. 2009/0046146,titled SURGICAL COMMUNICATION AND CONTROL SYSTEM, which published onFeb. 19, 2009, which is herein incorporated by reference in itsentirety. FIG. 53 illustrates a diagram 6680 of a beam source andcombined beam detector system utilized as a device control mechanism inan operating theater. The system 6680 is configured and wired to allowfor device control with the overlay generated on the primary proceduraldisplay. The footswitch shows a method to allow the user to click oncommand icons that would appear on the screen while the beam source isused to aim at the particular desired command icon to be clicked. Thecontrol system graphic user interface (GUI) and device control processorcommunicate and parameters are changed using the system. The system 6680includes a display 6684 coupled to a beam detecting sensor 6682 and ahead mounted source 6686. The beam detecting sensor 6682 is incommunication with a control system GUI overlay processor and beamsource processor 6688. The surgeon operates a footswitch 6692 or otheradjunctive switch, which provides a signal to a device control interfaceunit 6694.

The system 6680 will provide a means for a sterile clinician to controlprocedural devices in an easy and quick, yet hands free and centralizedfashion. The ability to maximize the efficiency of the operation andminimize the time a patient is under anesthesia is important to the bestpatient outcomes. It is common for surgeons, cardiologists orradiologists to verbally request adjustments be made to certain medicaldevices and electronic equipment used in the procedure outside thesterile field. It is typical that he or she must rely on another staffmember to make the adjustments he or she needs to settings on devicessuch as cameras, bovies, surgical beds, shavers, insufflators,injectors, to name a few. In many circumstances, having to command astaff member to make a change to a setting can slow down a procedurebecause the non-sterile staff member is busy with another task. Thesterile physician cannot adjust non-sterile equipment withoutcompromising sterility, so he or she must often wait for the non-sterilestaff member to make the requested adjustment to a certain device beforeresuming the procedure.

The system 6680 allows a user to use a beam source and beam detector toregenerate a pointer overlay coupled with a GUI and a concurrentswitching method (i.e., a foot switch, etc.) to allow the clinician toclick through commands on the primary display. In one aspect, a GUIcould appear on the procedural video display when activated, such aswhen the user tilts his or her head twice to awaken it or steps on afoot switch provided with the system. Or it is possible that a righthead tilt wakes up the system, and a left head tilt simply activates thebeam source. When the overlay (called device control GUI overlay)appears on the screen it shows button icons representing varioussurgical devices and the user can use the beam source, in this case alaser beam, to aim at the button icons. Once the laser is over theproper button icon, a foot switch, or other simultaneous switch methodcan be activated, effectively acting like a mouse click on a computer.For example a user can “wake up” the system, causing a the devicecontrol GUI overlay to pop up that lists button icons on the screen,each one labeled as a corresponding procedural medical device. The usercan point the laser at the correct box or device and click a foot pedal(or some other concurrent control—like voice control, waistband button,etc.) to make a selection, much like clicking a mouse on a computer. Thesterile physician can then select “insufflator, for example” Thesubsequent screen shows arrow icons that can be clicked for varioussettings for the device that need to be adjusted (pressure, rate, etc.).In one iteration, the user can then can point the laser at the up arrowand click the foot pedal repeatedly until the desired setting isattained.

In one aspect, components of the system 6680 could be coupled withexisting robotic endoscope holders to “steer” a rigid surgicalendoscopic camera by sending movement commands to the robotic endoscopeholding arm (provided separately, i.e., AESOP by Computer Motion). Theendoscope is normally held by an assistant nurse or resident physician.There are robotic and mechanical scope holders currently on the marketand some have even had been introduced with voice control. However,voice control systems have often proven cumbersome, slow and inaccurate.This aspect would employ a series of software and hardware components toallow the overlay to appear as a crosshair on the primary proceduralvideo screen. The user could point the beam source at any part of thequadrant and click a simultaneous switch, such as a foot pedal, to sendmovement commands to the existing robotic arm, which, when coupled withthe secondary trigger (i.e., a foot switch, waist band switch, etc.)would send a command to adjust the arm in minute increments in thedirection of the beam source. It could be directed by holding down thesecondary trigger until the desired camera angle and position isachieved and then released. This same concept could be employed forsurgical bed adjustments by having the overlay resemble the controls ofa surgical bed. The surgical bed is commonly adjusted during surgery toallow better access to the anatomy. Using the combination of the beamsource, in this case a laser, a beam detecting sensor such as a camera,a control system GUI overlay processing unit and beam source processor,and a device control interface unit, virtually any medical device couldbe controlled through this system. Control codes would be programmedinto the device control interface unit, and most devices can beconnected using an RS-232 interface, which is a standard for serialbinary data signals connecting between a DTE (Data Terminal Equipment)and a DCE (Data Circuit-terminating Equipment). The present inventionwhile described with reference to application in the medical field canbe expanded/modified for use in other fields. Another use of thisinvention could be in helping those who are without use of their handsdue to injury or handicap or for professions where the hands areoccupied and hands free interface is desired.

Surgical Hub with Direct Interface Control with Secondary SurgeonDisplay Units Designed to be within the Sterile Field and Accessible forInput and Display by the Surgeon

In one aspect, the surgical hub 206 provides a secondary user interfacethat enables display and control of surgical hub 206 functions from withthe sterile field. The secondary display could be used to change displaylocations, what information is displayed where, pass off control ofspecific functions or devices.

During a surgical procedure, the surgeon may not have a user interfacedevice accessible for interactive input by the surgeon and displaywithin the sterile field. Thus, the surgeon cannot interface with theuser interface device and the surgical hub from within the sterile fieldand cannot control other surgical devices through the surgical hub fromwithin the sterile field.

One solution provides a display unit designed to be used within thesterile field and accessible for input and display by the surgeon toallow the surgeon to have interactive input control from the sterilefield to control other surgical devices coupled to the surgical hub. Thedisplay unit is sterile and located within the sterile field to allowthe surgeons to interface with the display unit and the surgical hub todirectly interface and configure instruments as necessary withoutleaving the sterile field. The display unit is a master device and maybe used for display, control, interchanges of tool control, allowingfeeds from other surgical hubs without the surgeon leaving the sterilefield.

In one aspect, the present disclosure provides a control unit,comprising an interactive touchscreen display, an interface configuredto couple the interactive touchscreen display to a surgical hub, aprocessor, and a memory coupled to the processor. The memory storesinstructions executable by the processor to receive input commands fromthe interactive touchscreen display located inside a sterile field andtransmits the input commands to a surgical hub to control devicescoupled to the surgical hub located outside the sterile field.

In another aspect, the present disclosure provides a control unit,comprising an interactive touchscreen display, an interface configuredto couple the interactive touchscreen display to a surgical hub, and acontrol circuit configured to receive input commands from theinteractive touchscreen display located inside a sterile field andtransmit the input commands to a surgical hub to control devices coupledto the surgical hub located outside the sterile field.

In another aspect, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, causes a machine to receive input commands from aninteractive touchscreen display located inside a sterile field andtransmit the input commands to a surgical hub through an interfaceconfigured to couple the interactive touchscreen display to the surgicalhub to control devices coupled to the surgical hub located outside thesterile field.

Providing a display unit designed to be used within the sterile fieldand accessible for input and display by the surgeon provides the surgeoninteractive input control from the sterile field to control othersurgical devices coupled to the surgical hub.

This display unit within the sterile field is sterile and allows thesurgeons to interface with it and the surgical hub. This gives thesurgeon control of the instruments coupled to the surgical hub andallows the surgeon to directly interface and configure the instrumentsas necessary without leaving the sterile field. The display unit is amaster device and may be used for display, control, interchanges of toolcontrol, allowing feeds from other surgical hubs without the surgeonleaving the sterile field.

In various aspects, the present disclosure provides a secondary userinterface to enable display and control of surgical hub functions fromwithin a sterile field. This control could be a display device like anI-pad, e.g., a portable interactive touchscreen display deviceconfigured to be introduced into the operating theater in a sterilemanner. It could be paired like any other device or it could be locationsensitive. The display device would be allowed to function in thismanner whenever the display device is placed over a specific location ofthe draped abdomen of the patient during a surgical procedure. In otheraspects, the present disclosure provides a smart retractor and a smartsticker. These and other aspects are described hereinbelow.

In one aspect, the present disclosure provides a secondary userinterface to enable display and control of surgical hub functions fromwithin the sterile field. In another aspect, the secondary display couldbe used to change display locations, determine what information andwhere the information is displayed, and pass off control of specificfunctions or devices.

There are four types of secondary surgeon displays in two categories.One type of secondary surgeon display units is designed to be usedwithin the sterile field and accessible for input and display by thesurgeon within the sterile field interactive control displays. Sterilefield interactive control displays may be shared or common sterile fieldinput control displays.

A sterile field display may be mounted on the operating table, on astand, or merely laying on the abdomen or chest of the patient. Thesterile field display is sterile and allows the surgeons to interfacewith the sterile field display and the surgical hub. This gives thesurgeon control of the system and allows them to directly interface andconfigure the sterile field display as necessary. The sterile fielddisplay may be configured as a master device and may be used fordisplay, control, interchanges of tool control, allowing feeds fromother surgical hubs, etc.

In one aspect, the sterile field display may be employed to re-configurethe wireless activation devices within the operating theater (OR) andtheir paired energy device if a surgeon hands the device to another.FIGS. 54A-54E illustrate various types of sterile field control and datainput consoles 6700, 6702, 6708, 6712, 6714 according to various aspectsof the present disclosure. Each of the disclosed sterile field controland data input consoles 6700, 6702, 6708, 6712, 6714 comprise at leastone touchscreen 6701, 6704/6706, 6709, 6713, 6716 input/output devicelayered on the top of an electronic visual display of an informationprocessing system. The sterile field control and data input consoles6700, 6702, 6708, 6712, 6714 may include batteries as a power source.Some include a cable 6710 to connect to a separate power source or torecharge the batteries. A user can give input or control the informationprocessing system through simple or multi-touch gestures by touching thetouchscreen 6701, 6704/6706, 6709, 6713, 6716 with a stylus, one or morefingers, or a surgical tool. The sterile field control and data inputconsoles 6700, 6702, 6708, 6712, 6714 may be used to re-configurewireless activation devices within the operating theater and a pairedenergy device if a surgeon hands the device to another surgeon. Thesterile field control and data input consoles 6700, 6702, 6708, 6712,6714 may be used to accept consult feeds from another operating theaterwhere it would then configure a portion of the operating theater screensor all of them to mirror the other operating theater so the surgeon isable to see what is needed to help. The sterile field control and datainput consoles 6700, 6702, 6708, 6712, 6714 are configured tocommunicate with the surgical hub 206. Accordingly, the description ofthe surgical hub 206 discussed in connection with FIGS. 1-11 isincorporated in this section by reference.

FIG. 54A illustrates a single zone sterile field control and data inputconsole 6700, according to one aspect of the present disclosure. Thesingle zone console 6700 is configured for use in a single zone within asterile field. Once deployed in a sterile field, the single zone console6700 can receive touchscreen inputs from a user in the sterile field.The touchscreen 6701 enables the user to interact directly with what isdisplayed, rather than using a mouse, touchpad, or other such devices(other than a stylus or surgical tool). The single zone console 6700includes wireless communication circuits to communicate wirelessly tothe surgical hub 206.

FIG. 54B illustrates a multi zone sterile field control and data inputconsole 6702, according to one aspect of the present disclosure. Themulti zone console 6702 comprises a first touchscreen 6704 to receive aninput from a first zone of a sterile field and a second touchscreen 6706to receive an input from a second zone of a sterile field. The multizone console 6702 is configured to receive inputs from multiple users ina sterile field. The multi zone console 6702 includes wirelesscommunication circuits to communicate wirelessly to the surgical hub206. Accordingly, the multi zone sterile field control and data inputconsole 6702 comprises an interactive touchscreen display with multipleinput and output zones.

FIG. 54C illustrates a tethered sterile field control and data inputconsole 6708, according to one aspect of the present disclosure. Thetethered console 6708 includes a cable 6710 to connect the tetheredconsole 6708 to the surgical hub 206 via a wired connection. The cable6710 enables the tethered console 6708 to communicate over a wired linkin addition to a wireless link. The cable 6710 also enables the tetheredconsole 6708 to connect to a power source for powering the console 6708and/or recharging the batteries in the console 6708.

FIG. 54D illustrates a battery operated sterile field control and datainput console 6712, according to one aspect of the present disclosure.The sterile field console 6712 is battery operated and includes wirelesscommunication circuits to communicate wirelessly with the surgical hub206. In particular, in one aspect, the sterile field console 6712 isconfigured to communicate with any of the modules coupled to the hub 206such as the generator module 240. Through the sterile field console6712, the surgeon can adjust the power output level of a generator usingthe touchscreen 6713 interface. One example is described below inconnection with FIG. 54E.

FIG. 54E illustrates a battery operated sterile field control and datainput console 6714, according to one aspect of the present disclosure.The sterile field console 6714 includes a user interface displayed onthe touchscreen of a generator. The surgeon can thus control the outputof the generator by touching the up/down arrow icons 6718A, 6718B thatincrease/decrease the power output of the generator module 240.Additional icons 6719 enable access to the generator module settings6174, volume 6178 using the +/− icons, among other features directlyfrom the sterile field console 6714. The sterile field console 6714 maybe employed to adjust the settings or reconfigure other wirelessactivations devices or modules coupled to the hub 206 within theoperating theater and their paired energy device when the surgeon handsthe sterile field console 6714 to another.

FIGS. 55A-55B illustrate a sterile field console 6700 in use in asterile field during a surgical procedure, according to one aspect ofthe present disclosure. FIG. 55A shows the sterile field console 6714positioned in the sterile field near two surgeons engaged in anoperation. In FIG. 55B, one of the surgeons is shown tapping thetouchscreen 6701 of the sterile field console with a surgical tool 6722to adjust the output of a modular device coupled to the surgical hub206, reconfigure the modular device, or an energy device paired with themodular device coupled to the surgical hub 206.

In another aspect, the sterile field display may be employed to acceptconsult feeds from another operating room (OR), such as anotheroperating theater or surgical hub 206, where it would then configure aportion of the OR screens or all of them to mirror the other ORs so thesurgeon could see what is needed to help. FIG. 56 illustrates a process6750 for accepting consult feeds from another operating room, accordingto one aspect of the present disclosure. The sterile field control anddata input consoles 6700, 6702, 6708, 6712, 6714 shown in FIGS. 54A-54E,55A-55B may be used as an interact-able scalable secondary displayallowing the surgeon to overlay other feeds or images from laser Dopplerimage scanning arrays or other image sources. The sterile field controland data input consoles 6700, 6702, 6708, 6712, 6714 may be used to callup a pre-operative scan or image to review. Laser Doppler techniques aredescribed in U.S. Provisional Patent Application No. 62/611,341, filedDec. 28, 2017, and titled INTERACTIVE SURGICAL PLATFORM, which isincorporated herein by reference in its entirety.

It is recognized that the tissue penetration depth of light is dependenton the wavelength of the light used. Thus, the wavelength of the lasersource light may be chosen to detect particle motion (such a bloodcells) at a specific range of tissue depth. A laser Doppler employsmeans for detecting moving particles such as blood cells based at avariety of tissue depths based on the laser light wavelength. A lasersource may be directed to a surface of a surgical site. A blood vessel(such as a vein or artery) may be disposed within the tissue at somedepth δ from the tissue surface. Red laser light (having a wavelength inthe range of about 635 nm to about 660 nm) may penetrate the tissue to adepth of about 1 mm. Green laser light (having a wavelength in the rangeof about 520 nm to about 532 nm) may penetrate the tissue to a depth ofabout 2-3 mm. Blue laser light (having a wavelength in the range ofabout 405 nm to about 445 nm) may penetrate the tissue to a depth ofabout 4 mm or greater. A blood vessel may be located at a depth of about2-3 mm below the tissue surface. Red laser light will not penetrate tothis depth and thus will not detect blood cells flowing within thisvessel. However, both green and blue laser light can penetrate thisdepth. Therefore, scattered green and blue laser light from the bloodcells will result in an observed Doppler shift in both the green andblue.

In some aspects, a tissue may be probed by red, green, and blue laserillumination in a sequential manner and the effect of such illuminationmay be detected by a CMOS imaging sensor over time. It may be recognizedthat sequential illumination of the tissue by laser illumination atdiffering wavelengths may permit a Doppler analysis at varying tissuedepths over time. Although red, green, and blue laser sources may beused to illuminate the surgical site, it may be recognized that otherwavelengths outside of visible light (such as in the infra red orultraviolet regions) may be used to illuminate the surgical site forDoppler analysis. The imaging sensor information may be provided to thesterile field control and data input consoles 6700, 6702, 6708, 6712,6714.

The sterile field control and data input consoles 6700, 6702, 6708,6712, 6714 provide access to past recorded data. In one operatingtheater designated as OR1, the sterile field control and data inputconsoles 6700, 6702, 6708, 6712, 6714 may be configured as “consultants”and to erase all data when the consultation is complete. In anotheroperating theater designated as OR3 (operating room 3), the sterilefield control and data input consoles 6700, 6702, 6708, 6712, 6714 maybe configured as a “consultees” and are configured to record all datareceived from operating theater OR1 (operating room 1) sterile fieldcontrol and data input consoles 6700, 6702, 6708, 6712, 6714. Theseconfigurations are summarized in TABLE 1 below:

TABLE 1 Sterile Field Control And Sterile Field Control And Data InputConsole In OR1 Data Input Console In OR3 Access to past recorded dataOR1 Consultant OR 3 Consultee Erase data when done Record all data

In one implementation of the process 6750, operating theater OR1receives 6752 a consult request from OR3. Data is transferred to the OR1sterile field control and data input console 6700, for example. The datais temporarily stored 6754. The data is backed up in time and the OR1view 6756 of the temporary data begins on the OR1 sterile field controland data input console 6700 touchscreen 6701. When the view is complete,the data is erased 6758 and control returns 6760 to OR1. The data isthen erased 6762 from the OR1 sterile field control and data inputconsole 6700 memory.

In yet another aspect, the sterile field display may be employed as aninteractable scalable secondary display allowing the surgeon to overlayother feeds or images like laser Doppler scanning arrays. In yet anotheraspect, the sterile field display may be employed to call up apre-operative scan or image to review. Once vessel path and depth anddevice trajectory are estimated, the surgeon employs a sterile fieldinteractable scalable secondary display allowing the surgeon to overlayother feeds or images.

FIG. 57 is a diagram 6770 that illustrates a technique for estimatingvessel path, depth, and device trajectory. Prior to dissecting a vessel6772, 6774 located below the surface of the tissue 6775 using a standardapproach, the surgeon estimates the path and depth of the vessel 6772,6774 and a trajectory 6776 of a surgical device 6778 will take to reachthe vessel 6772, 6774. It is often difficult to estimate the path anddepth 6776 of a vessel 6772, 6774 located below the surface of thetissue 6775 because the surgeon cannot accurately visualize the locationof the vessel 6772, 6774 path and depth 6776.

FIGS. 58A-58D illustrate multiple real time views of images of a virtualanatomical detail for dissection including perspective views (FIGS. 58A,58C) and side views (FIGS. 58B, 58D). The images are displayed on asterile field display of tablet computer or sterile field control anddata input console employed as an interactable scalable secondarydisplay allowing the surgeon to overlay other feeds or images, accordingto one aspect of the present disclosure. The images of the virtualanatomy enable the surgeon to more accurately predict the path and depthof a vessel 6772, 6774 located below the surface of the tissue 6775 asshown in FIG. 57 and the best trajectory 6776 of the surgical device6778.

FIG. 58A is a perspective view of a virtual anatomy 6780 displayed on atablet computer or sterile field control and data input console. FIG.58B is a side view of the virtual anatomy 6780 shown in FIG. 58A,according to one aspect of the present disclosure. With reference toFIGS. 58A-58B, in one aspect, the surgeon uses a smart surgical device6778 and a tablet computer to visualize the virtual anatomy 6780 in realtime and in multiple views. The three dimensional perspective viewincludes a portion of tissue 6775 in which the vessels 6772, 6774 arelocated below surface. The portion of tissue is overlaid with a grid6786 to enable the surgeon to visualize a scale and gauge the path anddepth of the vessels 6772, 6774 at target locations 6782, 6784 eachmarked by an X. The grid 6786 also assists the surgeon determine thebest trajectory 6776 of the surgical device 6778. As illustrated, thevessels 6772, 6774 have an unusual vessel path.

FIG. 58C illustrates a perspective view of the virtual anatomy 6780 fordissection, according to one aspect of the present disclosure. FIG. 58Dis a side view of the virtual anatomy 6780 for dissection, according toone aspect of the present disclosure. With reference to FIGS. 58C-58D,using the tablet computer, the surgeon can zoom and pan 360° to obtainan optimal view of the virtual anatomy 6780 for dissection. The surgeonthen determines the best path or trajectory 6776 to insert the surgicaldevice 6778 (e.g., a dissector in this example). The surgeon may viewthe anatomy in a three-dimensional perspective view or any one of sixviews. See for example the side view of the virtual anatomy in FIG. 58Dand the insertion of the surgical device 6778 (e.g., the dissector).

In another aspect, a sterile field control and data input console mayallow live chatting between different departments, such as, for example,with the oncology or pathology department, to discuss margins or otherparticulars associated with imaging. The sterile field control and datainput console may allow the pathology department to tell the surgeonabout relationships of the margins within a specimen and show them tothe surgeon in real time using the sterile field console.

In another aspect, a sterile field control and data input console may beused to change the focus and field of view of its own image or controlthat of any of the other monitors coupled to the surgical hub.

In another aspect, a sterile field control and data input console may beused to display the status of any of the equipment or modules coupled tothe surgical hub 206. Knowledge of which device coupled to the surgicalhub 206 is being used may be obtained via information such as the deviceis not on the instrument pad or on-device sensors. Based on thisinformation, the sterile field control and data input console may changedisplay, configurations, switch power to drive one device, and notanother, one cord from capital to instrument pad and multiple cords fromthere. Device diagnostics may obtain knowledge that the device isinactive or not being used. Device diagnostics may be based oninformation such as the device is not on the instrument pad or basedon-device sensors.

In another aspect, a sterile field control and data input console may beused as a learning tool. The console may display checklists, proceduresteps, and/or sequence of steps. A timer/clock may be displayed tomeasure time to complete steps and/or procedures. The console maydisplay room sound pressure level as indicator for activity, stress,etc.

FIGS. 59A-59B illustrate a touchscreen display 6890 that may be usedwithin the sterile field, according to one aspect of the presentdisclosure. Using the touchscreen display 6890, a surgeon can manipulateimages 6892 displayed on the touchscreen display 6890 using a variety ofgestures such as, for example, drag and drop, scroll, zoom, rotate, tap,double tap, flick, drag, swipe, pinch open, pinch close, touch and hold,two-finger scroll, among others.

FIG. 59A illustrates an image 6892 of a surgical site displayed on atouchscreen display 6890 in portrait mode. FIG. 59B shows thetouchscreen display 6890 rotated 6894 to landscape mode and the surgeonuses his index finger 6896 to scroll the image 6892 in the direction ofthe arrows. FIG. 59C shows the surgeon using his index finger 6896 andthumb 6898 to pinch open the image 6892 in the direction of the arrows6899 to zoom in. FIG. 59D shows the surgeon using his index finger 6896and thumb 6898 to pinch close the image 6892 in the direction of thearrows 6897 to zoom out. FIG. 59E shows the touchscreen display 6890rotated in two directions indicated by arrows 6894, 6896 to enable thesurgeon to view the image 6892 in different orientations.

Outside the sterile field, control and static displays are used that aredifferent from the control and static displays used inside the sterilefield. The control and static displays located outside the sterile fieldprovide interactive and static displays for operating theater (OR) anddevice control. The control and static displays located outside thesterile field may include secondary static displays and secondarytouchscreens for input and output.

Secondary static non-sterile displays 107, 109, 119 (FIG. 2) for usedoutside the sterile field include monitors placed on the wall of theoperating theater, on a rolling stand, or on capital equipment. A staticdisplay is presented with a feed from the control device to which theyare attached and merely displays what is presented to it.

Secondary touch input screens located outside the sterile field may bepart of the visualization system 108 (FIG. 2), part of the surgical hub108 (FIG. 2), or may be fixed placement touch monitors on the walls orrolling stands. One difference between secondary touch input screens andstatic displays is that a user can interact with a secondary touch inputscreen by changing what is displayed on that specific monitor or others.For capital equipment applications, it could be the interface to controlthe setting of the connected capital equipment. The secondary touchinput screens and the static displays outside the sterile field can beused to preload the surgeon's preferences (instrumentation settings andmodes, lighting, procedure and preferred steps and sequence, music,etc.)

Secondary surgeon displays may include personal input displays with apersonal input device that functions similarly to the common sterilefield input display device but it is controlled by a specific surgeon.Personal secondary displays may be implemented in many form factors suchas, for example, a watch, a small display pad, interface glasses, etc. Apersonal secondary display may include control capabilities of a commondisplay device and since it is located on or controlled by a specificsurgeon, the personal secondary display would be keyed to him/herspecifically and would indicate that to others and itself. Generallyspeaking, a personal secondary display would normally not be useful toexchanging paired devices because they are not accessible to more thanone surgeon. Nevertheless, a personal secondary display could be used togrant permission for release of a device.

A personal secondary display may be used to provide dedicated data toone of several surgical personnel that wants to monitor something thatthe others typically would not want to monitor. In addition, a personalsecondary display may be used as the command module. Further, a personalsecondary display may be held by the chief surgeon in the operatingtheater and would give the surgeon the control to override any of theother inputs from anyone else. A personal secondary display may becoupled to a short range wireless, e.g., Bluetooth, microphone andearpiece allowing the surgeon to have discrete conversations or calls orthe personal secondary display may be used to broadcast to all theothers in the operating theater or other department.

FIG. 60 illustrates a surgical site 6900 employing a smart surgicalretractor 6902 comprising a direct interface control to a surgical hub206 (FIGS. 1-11), according to one aspect of the present disclosure. Thesmart surgical retractor 6902 helps the surgeon and operating roomprofessionals hold an incision or wound open during surgical procedures.The smart surgical retractor 6902 aids in holding back underlying organsor tissues, allowing doctors/nurses better visibility and access to theexposed area. With reference also to FIGS. 1-11, the smart surgicalretractor 6902 may comprise an input display 6904 operated by the smartsurgical retractor 6902. The smart surgical retractor 6902 may comprisea wireless communication device to communicate with a device connectedto a generator module 240 coupled to the surgical hub 206. Using theinput display 6904 of the smart surgical retractor 6902, the surgeon canadjust power level or mode of the generator module 240 to cut and/orcoagulate tissue. If using automatic on/off for energy delivery onclosure of an end effector on the tissue, the status of automatic on/offmay be indicated by a light, screen, or other device located on thesmart retractor 6902 housing. Power being used may be changed anddisplayed.

In one aspect, the smart surgical retractor 6902 can sense or know whatdevice/instrument 235 the surgeon is using, either through the surgicalhub 206 or RFID or other device placed on the device/instrument 235 orthe smart surgical retractor 6902, and provide an appropriate display.Alarm and alerts may be activated when conditions require. Otherfeatures include displaying the temperature of the ultrasonic blade,nerve monitoring, light source 6906 or fluorescence. The light source6906 may be employed to illuminate the surgical field of view 6908 andto charge photocells 6918 on single use sticker display that stick ontothe smart retractor 6902 (see FIG. 61, for example). In another aspect,the smart surgical retractor 6902 may include an augmented realityprojected on the patient's anatomy (e.g., like a vein viewer).

FIG. 61 illustrates a surgical site 6910 with a smart flexible stickerdisplay 6912 attached to the body/skin 6914 of a patient, according toone aspect of the present disclosure. As shown, the smart flexiblesticker display 6912 is applied to the body/skin 6914 of a patientbetween the area exposed by the surgical retractors 6916. In one aspect,the smart flexible sticker display 6912 may be powered by light, an onboard battery, or a ground pad. The flexible sticker display 6912 maycommunicate via short range wireless (e.g., Bluetooth) to a device, mayprovide readouts, lock power, or change power. The smart flexiblesticker display 6912 also comprises photocells 6918 to power the smartflexible sticker display 6912 using ambient light energy. The flexiblesticker display 6912 includes a display of a control panel 6920 userinterface to enable the surgeon to control devices 235 or other modulescoupled to the surgical hub 206 (FIGS. 1-11).

FIG. 62 is a logic flow diagram 6920 of a process depicting a controlprogram or a logic configuration to communicate from inside a sterilefield to a device located outside the sterile field, according to oneaspect of the present disclosure. In one aspect, a control unitcomprises an interactive touchscreen display, an interface configured tocouple the interactive touchscreen display to a surgical hub, aprocessor, and a memory coupled to the processor. The memory storesinstructions executable by the processor to receive 6922 input commandsfrom the interactive touchscreen display located inside a sterile fieldand transmits 6924 the input commands to a surgical hub to controldevices coupled to the surgical hub located outside the sterile field.

FIG. 63 illustrates a system for performing surgery. The systemcomprises a control box which includes internal circuitry; a surgicalinstrument including a distal element and techniques for sensing aposition or condition of said distal element; techniques associated withsaid surgical instrument for transmitting said sensed position orcondition to said internal circuitry of said control box; and fortransmitting said sensed position or condition from said internalcircuitry of said control box to a video monitor for display thereon,wherein said sensed position or condition is displayed on said videomonitor as an icon or symbol, further comprising a voltage source forgenerating a voltage contained entirely within said surgical instrument.Further examples are disclosed in U.S. Pat. No. 5,503,320, titledSURGICAL APPARATUS WITH INDICATOR, which issued on Apr. 2, 1996, whichis herein incorporated by reference in its entirety.

FIG. 63 shows schematically a system whereby data is transmitted to avideo monitor for display, such data relating to the position and/orcondition of one or more surgical instruments. As shown in FIG. 63, alaparoscopic surgical procedure is being performed wherein a pluralityof trocar sleeves 6930 are inserted through a body wall 6931 to provideaccess to a body cavity 6932. A laparoscope 6933 is inserted through oneof the trocar sleeves 6930 to provide illumination (light cable 6934 isshown leading toward a light source, not pictured) to the surgical siteand to obtain an image thereof. A camera adapter 6935 is attached at theproximal end of laparoscope 6933 and image cable 6936 extends therefromto a control box 6937 discussed in more detail below. Image cable inputsto image receiving port 416 on control box 6937.

Additional surgical instruments 6939, 6940 are inserted throughadditional trocar sleeves 6900 which extend through body wall 6931. InFIG. 63, instrument 6939 schematically illustrates an endoscopicstapling device, e.g., an Endo GIA* instrument manufactured by theassignee of this application, and instrument 6940 schematicallyillustrates a hand instrument, e.g., an Endo Grasp* device alsomanufactured by the present assignee. Additional and/or alternativeinstruments may also be utilized according to the present invention; theillustrated instruments are merely exemplary of surgical instrumentswhich may be utilized according to the present invention.

Instruments 6939, 6940 include adapters 6941, 6942 associated with theirrespective handle portions. The adapters electronically communicate withconductive mechanisms (not pictured). These mechanisms, which includeelectrically conductive contact members electrically connected by wires,cables and the like, are associated with the distal elements of therespective instruments, e.g., the anvil 6943 and cartridge 6944 of theEndo GIA* instrument, the jaws 6945, 6946 of the Endo Grasp* device, andthe like. The mechanisms are adapted to interrupt an electronic circuitwhen the distal elements are in a first position or condition and tocomplete the electronic circuit when the distal elements are in a secondposition or condition. A voltage source for the electronic circuit maybe provided in the surgical instrument, e.g., in the form of a battery,or supplied from control box 6937 through cables 6947, 6948.

Control box 6937 includes a plurality of jacks 6949 which are adapted toreceive cables 6947, 6948 and the like. Control box 6937 furtherincludes an outgoing adapter 6950 which is adapted to cooperate with acable 6951 for transmitting the laparoscopic image obtained by thelaparoscope 6933 together with data concerning surgical instruments6939, 6940 to video monitor 6952. Circuitry within control box 6937 isprovided for converting the presence of an interrupted circuit, e.g.,for the electronics within cable 6947 and the mechanism associated withthe distal elements of instrument 6939, to an icon or symbol for displayon video monitor 6952. Similarly, the circuitry within control box 6937is adapted to provide a second icon or symbol to video monitor 6952 whena completed circuit exists for cable 6947 and the associated mechanism.

Illustrative icons/symbols 6953, 6954 are shown on video monitor 6952.Icon 6953 shows a surgical staple and could be used to communicate tothe surgeon that the cartridge 6944 and anvil 6943 of instrument 6939are properly positioned to form staples in tissue 6955. Icon 6953 couldtake another form when the cartridge 6944 and anvil 6943 are notproperly positioned for forming staples, thereby interrupting thecircuit. Icon 6954 shows a hand instrument with jaws spread apart,thereby communicating to the surgeon that the jaws 6945, 6946 ofinstrument 6940 are open. Icon 6954 could take another form when jaws6945, 6946 are closed, thereby completing the circuit.

FIG. 64 illustrates a second layer of information overlaying a firstlayer of information. The second layer of information includes asymbolic representation of the knife overlapping the detected positionof the knife in the DLU depicted in the first layer of information.Further examples are disclosed in U.S. Pat. No. 9,283,054, titledSURGICAL APPARATUS WITH INDICATOR, which issued on Mar. 15, 2016, whichis herein incorporated by reference in its entirety.

Referring to FIG. 64, the second layer of information 6963 can overlayat least a portion of the first layer of information 6962 on the display6960. Furthermore, the touch screen 6961 can allow a user to manipulatethe second layer of information 6963 relative to the video feedback inthe underlying first layer of information 6962 on the display 6960. Forexample, a user can operate the touch screen 6961 to select, manipulate,reformat, resize, and/or otherwise modify the information displayed inthe second layer of information 6963. In certain aspects, the user canuse the touch screen 6961 to manipulate the second layer of information6963 relative to the surgical instrument 6964 depicted in the firstlayer of information 6962 on the display 6960. A user can select a menu,category and/or classification of the control panel 6967 thereof, forexample, and the second layer of information 6963 and/or the controlpanel 6967 can be adjusted to reflect the user's selection. In variousaspects, a user may select a category from the instrument feedbackcategory 6969 that corresponds to a specific feature or features of thesurgical instrument 6964 depicted in the first layer of information6962. Feedback corresponding to the user-selected category can move,locate itself, and/or “snap” to a position on the display 6960 relativeto the specific feature or features of the surgical instrument 6964. Forexample, the selected feedback can move to a position near and/oroverlapping the specific feature or features of the surgical instrument6964 depicted in the first layer of information 6962.

The instrument feedback menu 6969 can include a plurality of feedbackcategories, and can relate to the feedback data measured and/or detectedby the surgical instrument 6964 during a surgical procedure. Asdescribed herein, the surgical instrument 6964 can detect and/or measurethe position 6970 of a moveable jaw between an open orientation and aclosed orientation, the thickness 6973 of clamped tissue, the clampingforce 6976 on the clamped tissue, the articulation 6974 of the DLU 6965,and/or the position 6971, velocity 6972, and/or force 6975 of the firingelement, for example. Furthermore, the feedback controller in signalcommunication with the surgical instrument 6964 can provide the sensedfeedback to the display 6960, which can display the feedback in thesecond layer of information 6963. As described herein, the selection,placement, and/or form of the feedback data displayed in the secondlayer of information 6963 can be modified based on the user's input tothe touch screen 6961, for example.

When the knife of the DLU 6965 is blocked from view by the end effectorjaws 6966 and/or tissue T, for example, the operator can track and/orapproximate the position of the knife in the DLU 6964 based on thechanging value of the feedback data and/or the shifting position of thefeedback data relative to the DLU 6965 depicted in the underlying firstlayer of information 6962.

In various aspects, the display menu 6977 of the control panel 6967 canrelate to a plurality of categories, such as unit systems 6978 and/ordata modes 6979, for example. In certain aspects, a user can select theunit systems category 6978 to switch between unit systems, such asbetween metric and U.S. customary units, for example. Additionally, auser can select the data mode category 6979 to switch between types ofnumerical representations of the feedback data and/or types of graphicalrepresentations of the feedback data, for example. The numericalrepresentations of the feedback data can be displayed as numericalvalues and/or percentages, for example. Furthermore, the graphicalrepresentations of the feedback data can be displayed as a function oftime and/or distance, for example. As described herein, a user canselect the instrument controller menu 6980 from the control panel 6967to input directives for the surgical instrument 6964, which can beimplemented via the instrument controller and/or the microcontroller,for example. A user can minimize or collapse the control panel 6967 byselecting the minimize/maximize icon 6968, and can maximize orun-collapse the control panel 6967 by re-selecting the minimize/maximizeicon 6968.

FIG. 65 depicts a perspective view of a surgeon using a surgicalinstrument that includes a handle assembly housing and a wirelesscircuit board during a surgical procedure, with the surgeon wearing aset of safety glasses. The wireless circuit board transmits a signal toa set of safety glasses worn by a surgeon using the surgical instrumentduring a procedure. The signal is received by a wireless port on thesafety glasses. One or more lighting devices on a front lens of thesafety glasses change color, fade, or glow in response to the receivedsignal to indicate information to the surgeon about the status of thesurgical instrument. The lighting devices are disposable on peripheraledges of the front lens to not distract the direct line of vision of thesurgeon. Further examples are disclosed in U.S. Pat. No. 9,011,427,titled SURGICAL INSTRUMENT WITH SAFETY GLASSES, which issued on Apr. 21,2015, which is herein incorporated by reference in its entirety.

FIG. 65 shows a version of safety glasses 6991 that may be worn by asurgeon 6992 during a surgical procedure while using a medical device.In use, a wireless communications board housed in a surgical instrument6993 may communicate with a wireless port 6994 on safety glasses 6991.Exemplary surgical instrument 6993 is a battery-operated device, thoughinstrument 6993 could be powered by a cable or otherwise. Instrument6993 includes an end effector. Particularly, wireless communicationsboard 6995 transmits one or more wireless signals indicated by arrows(B, C) to wireless port 6994 of safety glasses 6991. Safety glasses 6991receive the signal, analyze the received signal, and display indicatedstatus information received by the signal on lenses 6996 to a user, suchas surgeon 6992, wearing safety glasses 6991. Additionally oralternatively, wireless communications board 6995 transmits a wirelesssignal to surgical monitor 6997 such that surgical monitor 6997 maydisplay received indicated status information to surgeon 6992, asdescribed above.

A version of the safety glasses 6991 may include lighting device onperipheral edges of the safety glasses 6991. A lighting device providesperipheral-vision sensory feedback of instrument 6993, with which thesafety glasses 6991 communicate to a user wearing the safety glasses6991. The lighting device may be, for example, a light-emitted diode(“LED”), a series of LEDs, or any other suitable lighting device knownto those of ordinary skill in the art and apparent in view of theteachings herein.

LEDs may be located at edges or sides of a front lens of the safetyglasses 6991 so not to distract from a user's center of vision whilestill being positioned within the user's field of view such that theuser does not need to look away from the surgical site to see thelighting device. Displayed lights may pulse and/or change color tocommunicate to the wearer of the safety glasses 6991 various aspects ofinformation retrieved from instrument 6993, such as system statusinformation or tissue sensing information (i.e., whether the endeffector has sufficiently severed and sealed tissue). Feedback fromhoused wireless communications board 6995 may cause a lighting device toactivate, blink, or change color to indicate information about the useof instrument 6993 to a user. For example, a device may incorporate afeedback mechanism based on one or more sensed tissue parameters. Inthis case, a change in the device output(s) based on this feedback insynch with a tone change may submit a signal through wirelesscommunications board 6995 to the safety glasses 6991 to triggeractivation of the lighting device. Such described means of activation ofthe lighting device should not be considered limiting as other means ofindicating status information of instrument 6993 to the user via thesafety glasses 6991 are contemplated. Further, the safety glasses 6991may be single-use or reusable eyewear. Button-cell power supplies suchas button-cell batteries may be used to power wireless receivers andLEDs of versions of safety glasses 6991, which may also include a housedwireless board and tri-color LEDs. Such button-cell power supplies mayprovide a low-cost means of providing sensory feedback of informationabout instrument 6993 when in use to surgeon 6992 wearing safety glasses6991.

FIG. 66 is a schematic diagram of a feedback control system forcontrolling a surgical instrument. The surgical instrument includes ahousing and an elongated shaft that extends distally from the housingand defines a first longitudinal axis. The surgical instrument alsoincludes a firing rod disposed in the elongated shaft and a drivemechanism disposed at least partially within the housing. The drivemechanism mechanically cooperates with the firing rod to move the firingrod. A motion sensor senses a change in the electric field (e.g.,capacitance, impedance, or admittance) between the firing rod and theelongated shaft. The measurement unit determines a parameter of themotion of the firing rod, such as the position, speed, and direction ofthe firing rod, based on the sensed change in the electric field. Acontroller uses the measured parameter of the motion of the firing rodto control the drive mechanism. Further examples are disclosed in U.S.Pat. No. 8,960,520, titled METHOD AND APPARATUS FOR DETERMININGPARAMETERS OF LINEAR MOTION IN A SURGICAL INSTRUMENT, which issued onFeb. 24, 2015, which is herein incorporated by reference in itsentirety.

With reference to FIG. 66, aspects of the present disclosure may includea feedback control system 6150. The system 6150 includes a feedbackcontroller 6152. The surgical instrument 6154 is connected to thefeedback controller 6152 via a data port, which may be either wired(e.g., FireWire®, USB, Serial RS232, Serial RS485, USART, Ethernet,etc.) or wireless (e.g., Bluetooth®, ANT3®, KNX®, Z-Wave X10®, WirelessUSB®, IrDA®, nanoNET®, TinyOS®, ZigBee®, 802.11 IEEE, and other radio,infrared, UHF, VHF communications and the like). The feedback controller6152 is configured to store the data transmitted to it by the surgicalinstrument 6154 as well as process and analyze the data. The feedbackcontroller 6152 is also connected to other devices, such as a videodisplay 6154, a video processor 6156 and a computing device 6158 (e.g.,a personal computer, a PDA, a smartphone, a storage device, etc.). Thevideo processor 6156 is used for processing output data generated by thefeedback controller 6152 for output on the video display 6154. Thecomputing device 6158 is used for additional processing of the feedbackdata. In one aspect, the results of the sensor feedback analysisperformed by a microcontroller may be stored internally for laterretrieval by the computing device 6158.

FIG. 67 illustrates a feedback controller 6152 including an on-screendisplay (OSD) module and a heads-up-display (HUD) module. The modulesprocess the output of a microcontroller for display on various displays.More specifically, the OSD module overlays text and/or graphicalinformation from the feedback controller 6152 over other video imagesreceived from the surgical site via cameras disposed therein. Themodified video signal having overlaid text is transmitted to the videodisplay allowing the user to visualize useful feedback information fromthe surgical instrument 6154 and/or feedback controller 6152 while stillobserving the surgical site. The feedback controller 6152 includes adata port 6160 coupled to a microcontroller which allows the feedbackcontroller 6152 to be connected to the computing device 6158 (FIG. 66).The data port 6160 may provide for wired and/or wireless communicationwith the computing device 6158 providing for an interface between thecomputing device 6158 and the feedback controller 6152 for retrieval ofstored feedback data, configuration of operating parameters of thefeedback controller 6152 and upgrade of firmware and/or other softwareof the feedback controller 6152.

The feedback controller 6152 includes a housing 6162 and a plurality ofinput and output ports, such as a video input 6164, a video output 6166,and a HUD display output 6168. The feedback controller 6152 alsoincludes a screen for displaying status information concerning thefeedback controller 6152.Further examples are disclosed in U.S. Pat. No.8,960,520, titled METHOD AND APPARATUS FOR DETERMINING PARAMETERS OFLINEAR MOTION IN A SURGICAL INSTRUMENT, which issued on Feb. 24, 2015,which is herein incorporated by reference in its entirety.

Situational Awareness

Situational awareness is the ability of some aspects of a surgicalsystem to determine or infer information related to a surgical procedurefrom data received from databases and/or instruments. The informationcan include the type of procedure being undertaken, the type of tissuebeing operated on, or the body cavity that is the subject of theprocedure. With the contextual information related to the surgicalprocedure, the surgical system can, for example, improve the manner inwhich it controls the modular devices (e.g. a robotic arm and/or roboticsurgical tool) that are connected to it and provide contextualizedinformation or suggestions to the surgeon during the course of thesurgical procedure.

Referring now to FIG. 68, a timeline 5200 depicting situationalawareness of a hub, such as the surgical hub 106 or 206, for example, isdepicted. The timeline 5200 is an illustrative surgical procedure andthe contextual information that the surgical hub 106, 206 can derivefrom the data received from the data sources at each step in thesurgical procedure. The timeline 5200 depicts the typical steps thatwould be taken by the nurses, surgeons, and other medical personnelduring the course of a lung segmentectomy procedure, beginning withsetting up the operating theater and ending with transferring thepatient to a post-operative recovery room.

The situationally aware surgical hub 106, 206 receives data from thedata sources throughout the course of the surgical procedure, includingdata generated each time medical personnel utilize a modular device thatis paired with the surgical hub 106, 206. The surgical hub 106, 206 canreceive this data from the paired modular devices and other data sourcesand continually derive inferences (i.e., contextual information) aboutthe ongoing procedure as new data is received, such as which step of theprocedure is being performed at any given time. The situationalawareness system of the surgical hub 106, 206 is able to, for example,record data pertaining to the procedure for generating reports, verifythe steps being taken by the medical personnel, provide data or prompts(e.g., via a display screen) that may be pertinent for the particularprocedural step, adjust modular devices based on the context (e.g.,activate monitors, adjust the field of view (FOV) of the medical imagingdevice, or change the energy level of an ultrasonic surgical instrumentor RF electrosurgical instrument), and take any other such actiondescribed above.

As the first step 5202 in this illustrative procedure, the hospitalstaff members retrieve the patient's EMR from the hospital's EMRdatabase. Based on select patient data in the EMR, the surgical hub 106,206 determines that the procedure to be performed is a thoracicprocedure.

Second step 5204, the staff members scan the incoming medical suppliesfor the procedure. The surgical hub 106, 206 cross-references thescanned supplies with a list of supplies that are utilized in varioustypes of procedures and confirms that the mix of supplies corresponds toa thoracic procedure. Further, the surgical hub 106, 206 is also able todetermine that the procedure is not a wedge procedure (because theincoming supplies either lack certain supplies that are necessary for athoracic wedge procedure or do not otherwise correspond to a thoracicwedge procedure).

Third step 5206, the medical personnel scan the patient band via ascanner that is communicably connected to the surgical hub 106, 206. Thesurgical hub 106, 206 can then confirm the patient's identity based onthe scanned data.

Fourth step 5208, the medical staff turns on the auxiliary equipment.The auxiliary equipment being utilized can vary according to the type ofsurgical procedure and the techniques to be used by the surgeon, but inthis illustrative case they include a smoke evacuator, insufflator, andmedical imaging device. When activated, the auxiliary equipment that aremodular devices can automatically pair with the surgical hub 106, 206that is located within a particular vicinity of the modular devices aspart of their initialization process. The surgical hub 106, 206 can thenderive contextual information about the surgical procedure by detectingthe types of modular devices that pair with it during this pre-operativeor initialization phase. In this particular example, the surgical hub106, 206 determines that the surgical procedure is a VATS procedurebased on this particular combination of paired modular devices. Based onthe combination of the data from the patient's EMR, the list of medicalsupplies to be used in the procedure, and the type of modular devicesthat connect to the hub, the surgical hub 106, 206 can generally inferthe specific procedure that the surgical team will be performing. Oncethe surgical hub 106, 206 knows what specific procedure is beingperformed, the surgical hub 106, 206 can then retrieve the steps of thatprocedure from a memory or from the cloud and then cross-reference thedata it subsequently receives from the connected data sources (e.g.,modular devices and patient monitoring devices) to infer what step ofthe surgical procedure the surgical team is performing.

Fifth step 5210, the staff members attach the EKG electrodes and otherpatient monitoring devices to the patient. The EKG electrodes and otherpatient monitoring devices are able to pair with the surgical hub 106,206. As the surgical hub 106, 206 begins receiving data from the patientmonitoring devices, the surgical hub 106, 206 thus confirms that thepatient is in the operating theater.

Sixth step 5212, the medical personnel induce anesthesia in the patient.The surgical hub 106, 206 can infer that the patient is under anesthesiabased on data from the modular devices and/or patient monitoringdevices, including EKG data, blood pressure data, ventilator data, orcombinations thereof, for example. Upon completion of the sixth step5212, the pre-operative portion of the lung segmentectomy procedure iscompleted and the operative portion begins.

Seventh step 5214, the patient's lung that is being operated on iscollapsed (while ventilation is switched to the contralateral lung). Thesurgical hub 106, 206 can infer from the ventilator data that thepatient's lung has been collapsed, for example. The surgical hub 106,206 can infer that the operative portion of the procedure has commencedas it can compare the detection of the patient's lung collapsing to theexpected steps of the procedure (which can be accessed or retrievedpreviously) and thereby determine that collapsing the lung is the firstoperative step in this particular procedure.

Eighth step 5216, the medical imaging device (e.g., a scope) is insertedand video from the medical imaging device is initiated. The surgical hub106, 206 receives the medical imaging device data (i.e., video or imagedata) through its connection to the medical imaging device. Upon receiptof the medical imaging device data, the surgical hub 106, 206 candetermine that the laparoscopic portion of the surgical procedure hascommenced. Further, the surgical hub 106, 206 can determine that theparticular procedure being performed is a segmentectomy, as opposed to alobectomy (note that a wedge procedure has already been discounted bythe surgical hub 106, 206 based on data received at the second step 5204of the procedure). The data from the medical imaging device 124 (FIG. 2)can be utilized to determine contextual information regarding the typeof procedure being performed in a number of different ways, including bydetermining the angle at which the medical imaging device is orientedwith respect to the visualization of the patient's anatomy, monitoringthe number or medical imaging devices being utilized (i.e., that areactivated and paired with the surgical hub 106, 206), and monitoring thetypes of visualization devices utilized. For example, one technique forperforming a VATS lobectomy places the camera in the lower anteriorcorner of the patient's chest cavity above the diaphragm, whereas onetechnique for performing a VATS segmentectomy places the camera in ananterior intercostal position relative to the segmental fissure. Usingpattern recognition or machine learning techniques, for example, thesituational awareness system can be trained to recognize the positioningof the medical imaging device according to the visualization of thepatient's anatomy. As another example, one technique for performing aVATS lobectomy utilizes a single medical imaging device, whereas anothertechnique for performing a VATS segmentectomy utilizes multiple cameras.As yet another example, one technique for performing a VATSsegmentectomy utilizes an infrared light source (which can becommunicably coupled to the surgical hub as part of the visualizationsystem) to visualize the segmental fissure, which is not utilized in aVATS lobectomy. By tracking any or all of this data from the medicalimaging device, the surgical hub 106, 206 can thereby determine thespecific type of surgical procedure being performed and/or the techniquebeing used for a particular type of surgical procedure.

Ninth step 5218, the surgical team begins the dissection step of theprocedure. The surgical hub 106, 206 can infer that the surgeon is inthe process of dissecting to mobilize the patient's lung because itreceives data from the RF or ultrasonic generator indicating that anenergy instrument is being fired. The surgical hub 106, 206 cancross-reference the received data with the retrieved steps of thesurgical procedure to determine that an energy instrument being fired atthis point in the process (i.e., after the completion of the previouslydiscussed steps of the procedure) corresponds to the dissection step. Incertain instances, the energy instrument can be an energy tool mountedto a robotic arm of a robotic surgical system.

Tenth step 5220, the surgical team proceeds to the ligation step of theprocedure. The surgical hub 106, 206 can infer that the surgeon isligating arteries and veins because it receives data from the surgicalstapling and cutting instrument indicating that the instrument is beingfired. Similarly to the prior step, the surgical hub 106, 206 can derivethis inference by cross-referencing the receipt of data from thesurgical stapling and cutting instrument with the retrieved steps in theprocess. In certain instances, the surgical instrument can be a surgicaltool mounted to a robotic arm of a robotic surgical system.

Eleventh step 5222, the segmentectomy portion of the procedure isperformed. The surgical hub 106, 206 can infer that the surgeon istransecting the parenchyma based on data from the surgical stapling andcutting instrument, including data from its cartridge. The cartridgedata can correspond to the size or type of staple being fired by theinstrument, for example. As different types of staples are utilized fordifferent types of tissues, the cartridge data can thus indicate thetype of tissue being stapled and/or transected. In this case, the typeof staple being fired is utilized for parenchyma (or other similartissue types), which allows the surgical hub 106, 206 to infer that thesegmentectomy portion of the procedure is being performed.

Twelfth step 5224, the node dissection step is then performed. Thesurgical hub 106, 206 can infer that the surgical team is dissecting thenode and performing a leak test based on data received from thegenerator indicating that an RF or ultrasonic instrument is being fired.For this particular procedure, an RF or ultrasonic instrument beingutilized after parenchyma was transected corresponds to the nodedissection step, which allows the surgical hub 106, 206 to make thisinference. It should be noted that surgeons regularly switch back andforth between surgical stapling/cutting instruments and surgical energy(i.e., RF or ultrasonic) instruments depending upon the particular stepin the procedure because different instruments are better adapted forparticular tasks. Therefore, the particular sequence in which thestapling/cutting instruments and surgical energy instruments are usedcan indicate what step of the procedure the surgeon is performing.Moreover, in certain instances, robotic tools can be utilized for one ormore steps in a surgical procedure and/or handheld surgical instrumentscan be utilized for one or more steps in the surgical procedure. Thesurgeon(s) can alternate between robotic tools and handheld surgicalinstruments and/or can use the devices concurrently, for example. Uponcompletion of the twelfth step 5224, the incisions are closed up and thepost-operative portion of the procedure begins.

Thirteenth step 5226, the patient's anesthesia is reversed. The surgicalhub 106, 206 can infer that the patient is emerging from the anesthesiabased on the ventilator data (i.e., the patient's breathing rate beginsincreasing), for example.

Lastly, the fourteenth step 5228 is that the medical personnel removethe various patient monitoring devices from the patient. The surgicalhub 106, 206 can thus infer that the patient is being transferred to arecovery room when the hub loses EKG, BP, and other data from thepatient monitoring devices. As can be seen from the description of thisillustrative procedure, the surgical hub 106, 206 can determine or inferwhen each step of a given surgical procedure is taking place accordingto data received from the various data sources that are communicablycoupled to the surgical hub 106, 206.

Situational awareness is further described in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is herein incorporated by reference in itsentirety. In certain instances, operation of a robotic surgical system,including the various robotic surgical systems disclosed herein, forexample, can be controlled by the hub 106, 206 based on its situationalawareness and/or feedback from the components thereof and/or based oninformation from the cloud 102.

Various aspects of the subject matter described herein are set out inthe following numbered examples.

Example 1. A surgical hub, comprising: a processor; and a memory coupledto the processor, the memory storing instructions executable by theprocessor to: receive first image data from a first image sensor,wherein the first image data represents a first field of view; receivesecond image data from a second image sensor, wherein the second imagedata represents a second field of view; and display, on a displaycoupled to the processor, a first image rendered from the first imagedata corresponding to the first field of view and a second imagerendered from the second image data corresponding to the second field ofview.

Example 2. The surgical hub of Example 1, wherein the first field ofview is a narrow angle field of view.

Example 3. The surgical hub of any one of Examples 1-2, wherein thefirst field of view is a wide angle field of view.

Example 4. The surgical hub of any one of Examples 1-3, wherein thememory stores instructions executable by the processor to augment thefirst image with the second image on the display.

Example 5. The surgical hub of any one of Examples 1-4, wherein thememory stores instructions executable by the processor to fuse the firstimage and the second image into a third image and display a fused imageon the display.

Example 6. The surgical hub of any one of Examples 1-5, wherein thefused image data comprises status information associated with a surgicaldevice, an image data integration landmark to interlock a plurality ofimages, and at least one guidance parameter.

Example 7. The surgical hub of any one of Examples 1-6, wherein thefirst image sensor is the same as the second image sensor and whereinthe first image data is captured as a first time by the first imagesensor and the second image data is captured at a second time by thefirst image sensor.

Example 8. The surgical hub of any one of Examples 1-7, wherein thememory stores instructions executable by the processor to: receive thirdimage data from a third image sensor, wherein the third image datarepresents a third field of view; generate composite image datacomprising the second and third image data; display the first image in afirst window of the display, wherein the first image corresponds to thefirst image data; and display a third image in a second window of thedisplay, wherein the third image corresponds to the composite imagedata.

Example 9. The surgical hub of any one of Examples 1-8, wherein thememory stores instructions executable by the processor to: receive thirdimage data from a third image sensor, wherein the third image datarepresents a third field of view; fuse the second and third image datato generate fused image data; display the first image in a first windowof the display, wherein the first image corresponds to the first imagedata; and display a third image in a second window of the display,wherein the third image corresponds to the fused image data.

Example 10. A surgical hub, comprising: a processor; and a memorycoupled to the processor, the memory storing instructions executable bythe processor to: detect a surgical device connection to the surgicalhub; transmit a control signal to the detected surgical device totransmit to the surgical hub surgical parameter data associated with thedetected surgical device; receive the surgical parameter data from thedetected surgical device; receive image data from an image sensor; anddisplay, on a display coupled to the surgical hub, an image renderedbased on the image data received from the image sensor in conjunctionwith the surgical parameter data received from the surgical device.

Example 11. The surgical hub of Example 10, wherein the surgical devicecomprises a local display that is separate from the display coupled tothe surgical hub.

Example 12. The surgical hub of any one of Examples 10-11, wherein thesurgical device connected to the surgical hub is configured toreconfigure the local display to present information that is differentfrom information presented when the surgical device is not connected tothe surgical hub.

Example 13. The surgical hub of any one of Examples 10-12, wherein aportion of information displayed on the local display is displayed onthe display coupled to the surgical hub.

Example 14. The surgical hub of any one of Examples 10-13, whereininformation displayed on the display coupled to the surgical hub ismirrored on the local display of the surgical device.

Example 15. A surgical hub, comprising: a control circuit configured to:detect a surgical device connection to the surgical hub; transmit acontrol signal to the detected surgical device to transmit to thesurgical hub surgical parameter data associated with the detectedsurgical device; receive the surgical parameter data from the detectedsurgical device; receive image data from an image sensor; and display,on a display coupled to the surgical hub, an image received from theimage sensor in conjunction with the surgical parameter data receivedfrom the surgical device.

Example 16. The surgical hub of Example 15, wherein the surgical devicecomprises a local display that is separate from the display coupled tothe surgical hub.

Example 17. The surgical hub of any one of Examples 15-16, wherein thesurgical device connected to the surgical hub is configured toreconfigure the local display to present information that is differentfrom information presented when the surgical device is not connected tothe surgical hub.

Example 18. The surgical hub of any one of Examples 15-17, wherein aportion of information displayed on the local display is displayed onthe display coupled to the surgical hub.

Example 19. The surgical hub of any one of Examples 15-18, whereininformation displayed on the display coupled to the surgical hub ismirrored on the local display of the surgical device.

Example 20. A non-transitory computer readable medium storing computerreadable instructions which, when executed, causes a machine to: detecta surgical device connection to the surgical hub; transmit a controlsignal to the detected surgical device to transmit to the surgical hubsurgical parameter data associated with the detected surgical device;receive the surgical parameter data from the detected surgical device;receive image data from an image sensor; and display, on a displaycoupled to the surgical hub, an image received from the image sensor inconjunction with the surgical parameter data received from the surgicaldevice.

Example 21. A non-transitory computer readable medium storing computerreadable instructions which, when executed, causes a machine to: receivefirst image data from a first image sensor, wherein the first image datarepresents a first field of view; receive second image data from asecond image sensor, wherein the second image data represents a secondfield of view; and display, on a display coupled to the surgical hub, afirst image corresponding to the first field of view and a second imagecorresponding to the second field of view.

While several forms have been illustrated and described, it is not theintention of the applicant to restrict or limit the scope of theappended claims to such detail. Numerous modifications, variations,changes, substitutions, combinations, and equivalents to those forms maybe implemented and will occur to those skilled in the art withoutdeparting from the scope of the present disclosure. Moreover, thestructure of each element associated with the described forms can bealternatively described as a means for providing the function performedby the element. Also, where materials are disclosed for certaincomponents, other materials may be used. It is therefore to beunderstood that the foregoing description and the appended claims areintended to cover all such modifications, combinations, and variationsas falling within the scope of the disclosed forms. The appended claimsare intended to cover all such modifications, variations, changes,substitutions, modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor comprising one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

1. A surgical hub, comprising: a processor; and a memory coupled to theprocessor, the memory storing instructions executable by the processorto: receive first image data from a first image sensor, wherein thefirst image data represents a first field of view; receive second imagedata from a second image sensor, wherein the second image datarepresents a second field of view; and display, on a display coupled tothe processor, a first image rendered from the first image datacorresponding to the first field of view and a second image renderedfrom the second image data corresponding to the second field of view. 2.The surgical hub of claim 1, wherein the first field of view is a narrowangle field of view.
 3. The surgical hub of claim 1, wherein the firstfield of view is a wide angle field of view.
 4. The surgical hub ofclaim 1, wherein the memory stores instructions executable by theprocessor to augment the first image with the second image on thedisplay.
 5. The surgical hub of claim 1, wherein the memory storesinstructions executable by the processor to fuse the first image and thesecond image into a third image and display a fused image on thedisplay.
 6. The surgical hub of claim 1, wherein the fused image datacomprises status information associated with a surgical device, an imagedata integration landmark to interlock a plurality of images, and atleast one guidance parameter.
 7. The surgical hub of claim 1, whereinthe first image sensor is the same as the second image sensor andwherein the first image data is captured as a first time by the firstimage sensor and the second image data is captured at a second time bythe first image sensor.
 8. The surgical hub of claim 1, wherein thememory stores instructions executable by the processor to: receive thirdimage data from a third image sensor, wherein the third image datarepresents a third field of view; generate composite image datacomprising the second and third image data; display the first image in afirst window of the display, wherein the first image corresponds to thefirst image data; and display a third image in a second window of thedisplay, wherein the third image corresponds to the composite imagedata.
 9. The surgical hub of claim 1, wherein the memory storesinstructions executable by the processor to: receive third image datafrom a third image sensor, wherein the third image data represents athird field of view; fuse the second and third image data to generatefused image data; display the first image in a first window of thedisplay, wherein the first image corresponds to the first image data;and display a third image in a second window of the display, wherein thethird image corresponds to the fused image data.
 10. A surgical hub,comprising: a processor; and a memory coupled to the processor, thememory storing instructions executable by the processor to: detect asurgical device connection to the surgical hub; transmit a controlsignal to the detected surgical device to transmit to the surgical hubsurgical parameter data associated with the detected surgical device;receive the surgical parameter data from the detected surgical device;receive image data from an image sensor; and display, on a displaycoupled to the surgical hub, an image rendered based on the image datareceived from the image sensor in conjunction with the surgicalparameter data received from the surgical device.
 11. The surgical hubof claim 10, wherein the surgical device comprises a local display thatis separate from the display coupled to the surgical hub.
 12. Thesurgical hub of claim 11, wherein the surgical device connected to thesurgical hub is configured to reconfigure the local display to presentinformation that is different from information presented when thesurgical device is not connected to the surgical hub.
 13. The surgicalhub of claim 11, wherein a portion of information displayed on the localdisplay is displayed on the display coupled to the surgical hub.
 14. Thesurgical hub of claim 11, wherein information displayed on the displaycoupled to the surgical hub is mirrored on the local display of thesurgical device.
 15. A surgical hub, comprising: a control circuitconfigured to: detect a surgical device connection to the surgical hub;transmit a control signal to the detected surgical device to transmit tothe surgical hub surgical parameter data associated with the detectedsurgical device; receive the surgical parameter data from the detectedsurgical device; receive image data from an image sensor; and display,on a display coupled to the surgical hub, an image received from theimage sensor in conjunction with the surgical parameter data receivedfrom the surgical device.
 16. The surgical hub of claim 15, wherein thesurgical device comprises a local display that is separate from thedisplay coupled to the surgical hub.
 17. The surgical hub of claim 16,wherein the surgical device connected to the surgical hub is configuredto reconfigure the local display to present information that isdifferent from information presented when the surgical device is notconnected to the surgical hub.
 18. The surgical hub of claim 16, whereina portion of information displayed on the local display is displayed onthe display coupled to the surgical hub.
 19. The surgical hub of claim16, wherein information displayed on the display coupled to the surgicalhub is mirrored on the local display of the surgical device.
 20. Anon-transitory computer readable medium storing computer readableinstructions which, when executed, causes a machine to: detect asurgical device connection to the surgical hub; transmit a controlsignal to the detected surgical device to transmit to the surgical hubsurgical parameter data associated with the detected surgical device;receive the surgical parameter data from the detected surgical device;receive image data from an image sensor; and display, on a displaycoupled to the surgical hub, an image received from the image sensor inconjunction with the surgical parameter data received from the surgicaldevice.
 21. A non-transitory computer readable medium storing computerreadable instructions which, when executed, causes a machine to: receivefirst image data from a first image sensor, wherein the first image datarepresents a first field of view; receive second image data from asecond image sensor, wherein the second image data represents a secondfield of view; and display, on a display coupled to the surgical hub, afirst image corresponding to the first field of view and a second imagecorresponding to the second field of view.